Provider Demographics
NPI:1306386446
Name:ANDERSON, KISHA (MS, LPC-I)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, LPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 WYNDHAM LN
Mailing Address - Street 2:STE 140
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0004
Mailing Address - Country:US
Mailing Address - Phone:972-259-0109
Mailing Address - Fax:972-805-9399
Practice Address - Street 1:4645 WYNDHAM LN
Practice Address - Street 2:STE 140
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0004
Practice Address - Country:US
Practice Address - Phone:972-259-0109
Practice Address - Fax:972-805-9399
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76284101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional