Provider Demographics
NPI:1467918078
Name:KINNISON, MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KINNISON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-1321
Mailing Address - Country:US
Mailing Address - Phone:816-965-1125
Mailing Address - Fax:
Practice Address - Street 1:2600 E 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1321
Practice Address - Country:US
Practice Address - Phone:816-965-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015013203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional