MEDICARE: MRS. KIMBERLY RENEE YONIKAS M.ED, LPC

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	101YP2500X	Professional Counselor	2454	OK

General Provider Information

NPI Number	:	1437169919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY RENEE YONIKAS M.ED, LPC

Provider Business Mailing Address
First Line	:	12 S JACKSON ST
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73034-4556
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2242 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8884
Country	:	US
Telephone Number	:	405-524-6500
Fax Number	:

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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