Provider Demographics
NPI:1073743530
Name:CRAWFORD KISSEL, LORETTA SUE ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:SUE ANN
Last Name:CRAWFORD KISSEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 66TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5200
Mailing Address - Country:US
Mailing Address - Phone:360-489-9151
Mailing Address - Fax:
Practice Address - Street 1:5805 66TH AVE SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5200
Practice Address - Country:US
Practice Address - Phone:360-489-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALC60349670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health