Provider Demographics
NPI:1558501858
Name:KULESZA, THOMAS C (MS)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:KULESZA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4063
Mailing Address - Country:US
Mailing Address - Phone:570-698-5659
Mailing Address - Fax:570-698-4013
Practice Address - Street 1:26 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE ARIEL
Practice Address - State:PA
Practice Address - Zip Code:18436-4063
Practice Address - Country:US
Practice Address - Phone:570-698-5659
Practice Address - Fax:570-698-4013
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000185101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
10686OtherNATIONAL BOARD FOR CERTIFIED COUNSELORS