Provider Demographics
NPI:1093247504
Name:MYTKO, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MYTKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24166
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-0166
Mailing Address - Country:US
Mailing Address - Phone:216-202-5196
Mailing Address - Fax:
Practice Address - Street 1:1513 MARS AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-3822
Practice Address - Country:US
Practice Address - Phone:216-202-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health