Healthcare Provider Details

I. General information

NPI: 1134827736
Provider Name (Legal Business Name): MISS CHEYANA ROSE MYCHACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 MONROE AVE STE 2
DUNMORE PA
18509-2497
US

IV. Provider business mailing address

56 LITTLE COVE RD
LAKE ARIEL PA
18436-8710
US

V. Phone/Fax

Practice location:
  • Phone: 570-483-8586
  • Fax:
Mailing address:
  • Phone: 570-914-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: