Healthcare Provider Details

I. General information

NPI: 1649092081
Provider Name (Legal Business Name): KUSIAK COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 S NEWCOMBE ST
LAKEWOOD CO
80227-5617
US

IV. Provider business mailing address

3377 S NEWCOMBE ST
LAKEWOOD CO
80227-5617
US

V. Phone/Fax

Practice location:
  • Phone: 970-471-2783
  • Fax:
Mailing address:
  • Phone: 970-471-2783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MEGHAN KUSIAK
Title or Position: OWNER/COUNSELOR
Credential: MA, LPC, NCC
Phone: 970-471-2783