Provider Demographics
NPI:1043381841
Name:TSOUKALAS, MARY (LPCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TSOUKALAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E WASHINGTON ST
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2196
Mailing Address - Country:US
Mailing Address - Phone:330-725-5333
Mailing Address - Fax:330-725-5314
Practice Address - Street 1:750 E WASHINGTON ST
Practice Address - Street 2:SUITE D-2
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2196
Practice Address - Country:US
Practice Address - Phone:330-725-5333
Practice Address - Fax:330-725-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health