Provider Demographics
NPI:1063391266
Name:CUSOLLE, TODD (BA)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:CUSOLLE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 N SCOTTSDALE RD STE 103
Mailing Address - Street 2:PMB556
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5280
Mailing Address - Country:US
Mailing Address - Phone:480-256-8102
Mailing Address - Fax:
Practice Address - Street 1:10869 N SCOTTSDALE RD STE 103
Practice Address - Street 2:PMB556
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5280
Practice Address - Country:US
Practice Address - Phone:480-256-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-01
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty