Provider Demographics
NPI:1669526653
Name:ZIELASKO, TYLER JAMES (MA, LMHC)
Entity type:Individual
Prefix:MR
First Name:TYLER
Middle Name:JAMES
Last Name:ZIELASKO
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 14TH ST
Mailing Address - Street 2:
Mailing Address - City:WINONA LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46590-1503
Mailing Address - Country:US
Mailing Address - Phone:407-920-5398
Mailing Address - Fax:
Practice Address - Street 1:3894 NEW VISION DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1708
Practice Address - Country:US
Practice Address - Phone:260-373-0880
Practice Address - Fax:260-373-0881
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor