=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023171337
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA KUSCHNITZKY MA. ED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2006
-----------------------------------------------------
Last Update Date | 12/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1640 POWERS FERRY RD
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-702-8474
-----------------------------------------------------
Fax | 214-324-4953
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 756 TERRELL CROSSING
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-702-8474
-----------------------------------------------------
Fax | 770-952-7565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 16425
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 006711
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------