Provider Demographics
NPI:1346094646
Name:KISSANA, HIRA SHAKEEL (AMFT)
Entity Type:Individual
Prefix:
First Name:HIRA
Middle Name:SHAKEEL
Last Name:KISSANA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 JEFFERSON ST # 1119
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3437
Mailing Address - Country:US
Mailing Address - Phone:707-853-8914
Mailing Address - Fax:
Practice Address - Street 1:3325 JEFFERSON ST # 1119
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3437
Practice Address - Country:US
Practice Address - Phone:707-853-8914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146349101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty