Provider Demographics
NPI:1619510294
Name:AIR CAPITAL COUNSELING & ASSESSMENT, LLC
Entity Type:Organization
Organization Name:AIR CAPITAL COUNSELING & ASSESSMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRZESKIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:316-347-7157
Mailing Address - Street 1:1029 N ROSE HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-9464
Mailing Address - Country:US
Mailing Address - Phone:316-347-7157
Mailing Address - Fax:316-247-9528
Practice Address - Street 1:1029 N ROSE HILL RD STE B
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-9464
Practice Address - Country:US
Practice Address - Phone:316-347-7157
Practice Address - Fax:316-247-9528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty