Provider Demographics
NPI:1174069975
Name:MISYUK, KHRYSTYNA (MHC)
Entity type:Individual
Prefix:
First Name:KHRYSTYNA
Middle Name:
Last Name:MISYUK
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 BAY PKWY
Mailing Address - Street 2:9M
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6439
Mailing Address - Country:US
Mailing Address - Phone:929-246-9191
Mailing Address - Fax:
Practice Address - Street 1:558 2ND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2608
Practice Address - Country:US
Practice Address - Phone:347-725-4301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health