Provider Demographics
NPI:1326435231
Name:ZUSTIAK, DANIEL ALEX (MA LMFT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEX
Last Name:ZUSTIAK
Suffix:
Gender:M
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 FREMONT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1122
Mailing Address - Country:US
Mailing Address - Phone:612-822-1357
Mailing Address - Fax:
Practice Address - Street 1:1516 W LAKE ST STE 110
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408
Practice Address - Country:US
Practice Address - Phone:612-872-8218
Practice Address - Fax:612-874-8885
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3014101Y00000X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health