MEDICARE: KHRYSTYNA MISYUK MHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	P04504	NY

General Provider Information

NPI Number	:	1174069975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHRYSTYNA MISYUK MHC

Provider Business Mailing Address
First Line	:	8855 BAY PKWY
Second Line	:	9M
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6439
Country	:	US
Telephone Number	:	929-246-9191
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 2ND ST
Second Line	:	SUITE 1
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2608
Country	:	US
Telephone Number	:	347-725-4301
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/17/2017

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