Provider Demographics
NPI:1174684054
Name:CESSNA, PHYLLIS KESSEL (MA LPC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:KESSEL
Last Name:CESSNA
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-1779
Mailing Address - Country:US
Mailing Address - Phone:304-267-9627
Mailing Address - Fax:304-263-0928
Practice Address - Street 1:1105 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-1779
Practice Address - Country:US
Practice Address - Phone:304-267-9627
Practice Address - Fax:304-263-0928
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health