Provider Demographics
NPI:1295829844
Name:MARY J. YANICS, PH.D., LLC
Entity Type:Organization
Organization Name:MARY J. YANICS, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE AND MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:YANICS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:913-341-9444
Mailing Address - Street 1:8340 MISSION ROAD
Mailing Address - Street 2:SUITE 228
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-341-9444
Mailing Address - Fax:913-341-9444
Practice Address - Street 1:8340 MISSION ROAD
Practice Address - Street 2:SUITE 228
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-341-9444
Practice Address - Fax:913-341-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSPSY 985103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS000A780Medicare ID - Type Unspecified