Healthcare Provider Details

I. General information

NPI: 1861107666
Provider Name (Legal Business Name): FREDERICK PETER JUSKALIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 MANNING PKWY
POWELL OH
43065-9171
US

IV. Provider business mailing address

1480 MANNING PKWY
POWELL OH
43065-9171
US

V. Phone/Fax

Practice location:
  • Phone: 614-888-9200
  • Fax:
Mailing address:
  • Phone: 614-888-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607169
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: