Provider Demographics
NPI:1619059821
Name:KISER, MARY ANNE (LCMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:KISER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:WULFSBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7315 E FRONTAGE ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-1658
Mailing Address - Country:US
Mailing Address - Phone:913-262-1160
Mailing Address - Fax:913-262-0818
Practice Address - Street 1:7315 E FRONTAGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-1658
Practice Address - Country:US
Practice Address - Phone:913-262-1160
Practice Address - Fax:913-262-0818
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS99106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist