Provider Demographics
NPI:1386933786
Name:MORYKON, MICHAEL (LPC LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:MORYKON
Suffix:
Gender:M
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LINKHORNE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3353
Mailing Address - Country:US
Mailing Address - Phone:434-384-1594
Mailing Address - Fax:
Practice Address - Street 1:2811 LINKHORNE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3353
Practice Address - Country:US
Practice Address - Phone:434-384-1594
Practice Address - Fax:434-384-3228
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001862101Y00000X
VA0717000148106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005406544Medicaid