Provider Demographics
NPI:1326180886
Name:KUZIEL, JOHN (LCPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KUZIEL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:MS
Mailing Address - Zip Code:39153
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 SALT CREEK LANE
Practice Address - Street 2:SUITE 114
Practice Address - City:ARLINTONG HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1089
Practice Address - Country:US
Practice Address - Phone:847-952-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001751101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-3045007OtherTAX ID#