Provider Demographics
NPI:1548064157
Name:PANCHENKO, OKSANA
Entity type:Individual
Prefix:MS
First Name:OKSANA
Middle Name:
Last Name:PANCHENKO
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 1:8300 BLUFF SPRINGS RD APT 1331
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-6879
Mailing Address - Country:US
Mailing Address - Phone:808-583-6399
Mailing Address - Fax:808-583-6399
Practice Address - Street 1:8300 BLUFF SPRINGS RD APT 1331
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-6879
Practice Address - Country:US
Practice Address - Phone:808-583-6399
Practice Address - Fax:808-583-6399
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100436101YM0800X
HIMHC-1131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty