Healthcare Provider Details

I. General information

NPI: 1356896807
Provider Name (Legal Business Name): KYLIE MARINKOVIC LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 WESTERN AVE
CHILLICOTHEE OH
45601-1104
US

IV. Provider business mailing address

1049 WESTERN AVE P.O. BOX 188
CHILLICOTHEE OH
45601-1104
US

V. Phone/Fax

Practice location:
  • Phone: 740-773-4366
  • Fax: 740-775-7855
Mailing address:
  • Phone: 740-773-4366
  • Fax: 740-775-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberE.1800928-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1500243
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: