Mycocun, Inc.

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

MYCOCUN, INC.

Practice address

115 Red Oak Dr
Lincoln University, PA 19352-8939

Phone

(267) 908-4664

NPI assigned

Mar 23, 2020

Last updated

Mar 23, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Morgan Rakay, MA, LPC, BC-DMT

Title

Clinical Director & Development

Phone

(267) 908-4664

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584921600000",
    "number": "1679100523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 RED OAK DR",
            "city": "LINCOLN UNIVERSITY",
            "state": "PA",
            "postal_code": "193528939",
            "telephone_number": "672-908-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 RED OAK DR",
            "city": "LINCOLN UNIVERSITY",
            "state": "PA",
            "postal_code": "193528939",
            "telephone_number": "267-908-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCOCUN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-23",
        "last_updated": "2020-03-23",
        "certification_date": "2020-03-23",
        "status": "A",
        "authorized_official_last_name": "RAKAY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "MORGAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR & DEVELOPMENT",
        "authorized_official_telephone_number": "267-908-4664",
        "authorized_official_credential": "MA, LPC, BC-DMT"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kross, DDS
• Janet Lennon, FNP
• Shannon Kay Macturk, M.A LCPC
• Tracy Martini, NP
• Antoinette A Moore, ATC
• Elizabeth Catherine Neils
• New London Counseling Center
• Melissa Nicastro
• Cheryl Lynn Nye, MED
• Frank Alphonse Pallante, PHYSICIAN ASSISTANT

• Counselor in Lincoln University, PA
• Providers in Lincoln University, PA by specialty
• Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.