Healthcare Provider Details

I. General information

NPI: 1831138718
Provider Name (Legal Business Name): DEBRA MARIE KUSZMAUL MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBRA MARIE MITCHELL

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 23 MILE RD STE 103
SHELBY TOWNSHIP MI
48315-2767
US

IV. Provider business mailing address

27550 SCHOOL SECTION RD
RICHMOND MI
48062-3833
US

V. Phone/Fax

Practice location:
  • Phone: 586-295-9704
  • Fax:
Mailing address:
  • Phone: 586-295-9704
  • Fax: 248-605-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401009324
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: