Provider Demographics
NPI:1316055007
Name:TUSAIE, KATHLEEN R (PHD, PMHCNS-BC)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:R
Last Name:TUSAIE
Suffix:
Gender:F
Credentials:PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-3311
Mailing Address - Country:US
Mailing Address - Phone:330-259-3664
Mailing Address - Fax:330-259-3665
Practice Address - Street 1:4505 LOGAN WAY
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-3311
Practice Address - Country:US
Practice Address - Phone:330-259-3664
Practice Address - Fax:330-259-3665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 140528163W00000X
OHNS-06906364S00000X, 364SP0807X, 364SP0808X
OHNS06906364SP0809X, 364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000205361OtherANTHEM
OHNS04131Medicaid
OH247528000OtherMAGELLAN
OH6200846OtherUNITED BEHAVIORAL HEALTH
OH137010OtherVALUE OPTIONS
OH2029581OtherCIGNA