Provider Demographics
NPI:1205226354
Name:HUTSELL, KARRISA DYAN (MA, LPC, PLAY THERAP)
Entity Type:Individual
Prefix:
First Name:KARRISA
Middle Name:DYAN
Last Name:HUTSELL
Suffix:
Gender:F
Credentials:MA, LPC, PLAY THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1348
Mailing Address - Country:US
Mailing Address - Phone:913-461-7852
Mailing Address - Fax:
Practice Address - Street 1:115 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1348
Practice Address - Country:US
Practice Address - Phone:913-461-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health