Provider Demographics
NPI:1568970721
Name:KISH, LANI ANN (BS)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:ANN
Last Name:KISH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:LANI
Other - Middle Name:ANN
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 WAGNER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6904
Mailing Address - Country:US
Mailing Address - Phone:253-858-2224
Mailing Address - Fax:253-858-2254
Practice Address - Street 1:6626 WAGNER WAY STE 200
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-6904
Practice Address - Country:US
Practice Address - Phone:253-858-2224
Practice Address - Fax:253-858-2254
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61152575101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health