Provider Information for 1326547282
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PABLO A KUSAK MA, LPC
Sex: Male
NPI: 1326547282
Last Updated: 2022-05-20
Certification Date: 2022-05-10
Certification Date: 2022-05-10
Details
Name | Value | ||||||||||||||||
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NPI | 1326547282 | ||||||||||||||||
Enumeration Date | 2018-02-06 | ||||||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||||||
Sole Proprietor | NO | ||||||||||||||||
Status | Active | ||||||||||||||||
Mailing Address | 3573 S 158TH PL BLDG B GILBERT, AZ 85297-2046 United States Phone: 480-271-4961 | Fax: | ||||||||||||||||
Primary Practice Address | 3573 S 158TH PL BLDG B GILBERT, AZ 85297-2046 United States Phone: 480-271-4961 | Fax: | ||||||||||||||||
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