Provider Demographics
NPI:1568152189
Name:MICHAEL KESSLER PSYD
Entity Type:Organization
Organization Name:MICHAEL KESSLER PSYD
Other - Org Name:FULL LIFE ASSESSMENT & THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:217-751-8995
Mailing Address - Street 1:3509 CARNOUSTIE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62712-5548
Mailing Address - Country:US
Mailing Address - Phone:217-751-8995
Mailing Address - Fax:
Practice Address - Street 1:4481 ASH GROVE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-6358
Practice Address - Country:US
Practice Address - Phone:217-751-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty