Provider Demographics
NPI:1417186289
Name:MARSHALL, KYSHEENNA SHERRELL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KYSHEENNA
Middle Name:SHERRELL
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KYSHEENNA
Other - Middle Name:SHERRELL
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:609 WOODLAND MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6055
Mailing Address - Country:US
Mailing Address - Phone:214-734-6579
Mailing Address - Fax:
Practice Address - Street 1:609 WOODLAND MANOR DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6055
Practice Address - Country:US
Practice Address - Phone:214-734-6579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX531201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical