| Doctor Name: | MS. KIM ELIZABETH KOYNOCK |
| NPI Number: | 1144564147 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, AT, LPC |
| License Number: | C.1000268 |
| Business Practice Address: | 408 North St Chardon, OH - 440241036 |
| Business Phone Number: | 4402853568 |
| Business Fax Number: | |
| Mailing Address: | 408 North St, CHARDON |
| State: | OH |
| Postal Code: | 440241036 |
| Phone Number: | 4402853568 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2012 |
| NPI Last Update Date: | 11/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C.1000268 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |