Provider Demographics
NPI:1114356805
Name:KUSAK, DARCY (MA)
Entity Type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:
Last Name:KUSAK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3573 S 158TH PL
Mailing Address - Street 2:BLDG B
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-2046
Mailing Address - Country:US
Mailing Address - Phone:480-748-5006
Mailing Address - Fax:480-265-4444
Practice Address - Street 1:3573 S 158TH PL
Practice Address - Street 2:BLDG B
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2046
Practice Address - Country:US
Practice Address - Phone:480-748-5006
Practice Address - Fax:480-265-4444
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13028101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional