Provider Demographics
NPI:1043649403
Name:KIESSLING AND ASSOCIATES PSYCHOLOGICAL GROUP
Entity Type:Organization
Organization Name:KIESSLING AND ASSOCIATES PSYCHOLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:BSA
Authorized Official - Phone:573-418-4730
Mailing Address - Street 1:PO BOX 6907
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-5008
Mailing Address - Country:US
Mailing Address - Phone:573-418-4730
Mailing Address - Fax:
Practice Address - Street 1:1108 W STEWART RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-2206
Practice Address - Country:US
Practice Address - Phone:573-418-4730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005023101YP2500X
MOSW0045431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty