Provider Demographics
NPI:1538481932
Name:OSEI KISSI, NYDRA T (LCSW)
Entity Type:Individual
Prefix:
First Name:NYDRA
Middle Name:T
Last Name:OSEI KISSI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17218 PRESTON RD STE 2800
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4018
Mailing Address - Country:US
Mailing Address - Phone:469-914-2683
Mailing Address - Fax:
Practice Address - Street 1:17218 PRESTON RD STE 2800
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4018
Practice Address - Country:US
Practice Address - Phone:469-914-2683
Practice Address - Fax:469-914-2684
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.013695104100000X
TX542011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker