Provider Demographics
NPI:1225493067
Name:WILCZYNSKI, TIEL MARIE (ATR, LPCC)
Entity Type:Individual
Prefix:
First Name:TIEL
Middle Name:MARIE
Last Name:WILCZYNSKI
Suffix:
Gender:F
Credentials:ATR, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 GREEN RD STE 404
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5716
Mailing Address - Country:US
Mailing Address - Phone:216-365-9007
Mailing Address - Fax:
Practice Address - Street 1:3681 GREEN RD STE 404
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5716
Practice Address - Country:US
Practice Address - Phone:216-342-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500233101Y00000X
OHE.1901291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor