Provider Demographics
NPI:1013959139
Name:SZYMANSKI, GERALD THOMAS (MA, LPC, LISAC)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:THOMAS
Last Name:SZYMANSKI
Suffix:
Gender:M
Credentials:MA, LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 S LAGUNA AVE
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344-4945
Mailing Address - Country:US
Mailing Address - Phone:928-669-6906
Mailing Address - Fax:928-669-6909
Practice Address - Street 1:1017 S LAGUNA AVE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-4945
Practice Address - Country:US
Practice Address - Phone:928-669-6906
Practice Address - Fax:928-669-6909
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10674101YA0400X
AZLPC-11595101YP2500X, 101YM0800X
AZLPC-10595101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ872748OtherAHCCCS #