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General NPI Number Information
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NPI Number | 1780959957
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Entity Type | Organization
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Legal Business Name | MARY J. YANICS, PH.D., LLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 8340 MISSION RD SUITE 228
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66206-1355
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Country | US
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Telephone | 913-341-9444
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Fax | 913-341-9444
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Provider Business Mailing Address
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Address Line | 8340 MISSION RD SUITE 228
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66206-1355
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Country | US
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Telephone | 913-341-9444
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Fax | 913-341-9444
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Authorized Official
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Title or Position | OWNER/SINGLE MEMBER
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Name | DR. MARY JEANNE YANICS
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Credential | PH.D.
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Telephone | 913-341-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 985
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License Number State | KS
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