Provider Demographics
NPI:1265748834
Name:KUCHAREK, JANELLEN (MA, LLPC)
Entity type:Individual
Prefix:MS
First Name:JANELLEN
Middle Name:
Last Name:KUCHAREK
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:WATERS
Mailing Address - State:MI
Mailing Address - Zip Code:49797-0325
Mailing Address - Country:US
Mailing Address - Phone:989-390-4256
Mailing Address - Fax:
Practice Address - Street 1:416 W MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1817
Practice Address - Country:US
Practice Address - Phone:989-390-4256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional