Provider Demographics
NPI:1376800151
Name:KULESZA, JUANITA M (COUNSELOR INTERN)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:M
Last Name:KULESZA
Suffix:
Gender:F
Credentials:COUNSELOR INTERN
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:M
Other - Last Name:KULESZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 THORNTON
Mailing Address - Street 2:P.O. BOX 599
Mailing Address - City:COTULLA
Mailing Address - State:TX
Mailing Address - Zip Code:78014
Mailing Address - Country:US
Mailing Address - Phone:210-954-1347
Mailing Address - Fax:
Practice Address - Street 1:611 THORNTON STREET
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014
Practice Address - Country:US
Practice Address - Phone:830-879-3047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10551101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor