MEDICARE: OLENA KOKHANOVA MS

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

General Provider Information

NPI Number	:	1235313404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLENA KOKHANOVA MS

Provider Business Mailing Address
First Line	:	300 BYBERRY RD
Second Line	:	UNIT 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1911
Country	:	US
Telephone Number	:	215-677-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 BYBERRY RD
Second Line	:	UNIT 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-1911
Country	:	US
Telephone Number	:	215-677-3261
Fax Number	:

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	12/24/2007

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