Provider Demographics
NPI:1427616556
Name:CYKON, JACQUELINE (M ED, LPCC-S, LICDC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CYKON
Suffix:
Gender:F
Credentials:M ED, LPCC-S, LICDC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GERMANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2980 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1834
Mailing Address - Country:US
Mailing Address - Phone:330-759-0276
Mailing Address - Fax:330-759-0030
Practice Address - Street 1:997 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4223
Practice Address - Country:US
Practice Address - Phone:330-758-0101
Practice Address - Fax:330-758-0128
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162448101YA0400X
OHC.2002454101YM0800X
OHE.2202867-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)