Provider Demographics
NPI:1437210283
Name:MYCHAJLUK, MYRON (CASAC)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:
Last Name:MYCHAJLUK
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 THORN AVE
Mailing Address - Street 2:SPECTRUM HUMAN SERVICES
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2600
Mailing Address - Country:US
Mailing Address - Phone:716-662-2040
Mailing Address - Fax:716-662-0019
Practice Address - Street 1:2040 SENECA ST
Practice Address - Street 2:SOUTH BUFFALO COUNSELING CENTER
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14210-2324
Practice Address - Country:US
Practice Address - Phone:716-828-0560
Practice Address - Fax:716-828-1522
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8568101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)