Healthcare Provider Details

I. General information

NPI: 1316055007
Provider Name (Legal Business Name): KATHLEEN R TUSAIE PHD, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 LOGAN WAY
HUBBARD OH
44425-3311
US

IV. Provider business mailing address

4505 LOGAN WAY
HUBBARD OH
44425-3311
US

V. Phone/Fax

Practice location:
  • Phone: 330-259-3664
  • Fax: 330-259-3665
Mailing address:
  • Phone: 330-259-3664
  • Fax: 330-259-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 140528
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberNS-06906
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-06906
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberNS-06906
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS06906
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code364SP0810X
TaxonomyChild & Family Psychiatric/Mental Health Clinical Nurse Specialist
License NumberNS06906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: