Healthcare Provider Details

I. General information

NPI: 1831474568
Provider Name (Legal Business Name): JULIE ANN KUSNIR COUNSELOR TRAINEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BELMONT AVE
YOUNGSTOWN OH
44502-1037
US

IV. Provider business mailing address

485 WILCOX RD APT 1
AUSTINTOWN OH
44515-4266
US

V. Phone/Fax

Practice location:
  • Phone: 330-744-2991
  • Fax:
Mailing address:
  • Phone: 330-207-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1100292-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: