Provider Demographics
NPI:1568639649
Name:CONSEEN, KYRIE ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KYRIE
Middle Name:ANN
Last Name:CONSEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LESLEY
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:14050 N 83RD AVE
Mailing Address - Street 2:STE 290
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:480-349-1031
Mailing Address - Fax:
Practice Address - Street 1:14050 N 83RD AVE
Practice Address - Street 2:STE 290
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5650
Practice Address - Country:US
Practice Address - Phone:480-349-1031
Practice Address - Fax:480-535-1510
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-123761041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ329691Medicaid