Provider Demographics
NPI:1548955172
Name:TLUSTOS, LANCE (CASAC-ADVANCED)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:TLUSTOS
Suffix:
Gender:M
Credentials:CASAC-ADVANCED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2957 DRUM RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-9732
Mailing Address - Country:US
Mailing Address - Phone:585-735-6912
Mailing Address - Fax:
Practice Address - Street 1:2957 DRUM RD
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-9732
Practice Address - Country:US
Practice Address - Phone:585-735-6912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)