Provider Demographics
NPI:1629834015
Name:TREY KISSACK COUNSELING
Entity Type:Organization
Organization Name:TREY KISSACK COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH PRACTICITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSACK
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP
Authorized Official - Phone:308-850-8862
Mailing Address - Street 1:1811 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5413
Mailing Address - Country:US
Mailing Address - Phone:308-850-8862
Mailing Address - Fax:
Practice Address - Street 1:1811 W 2ND ST STE 450
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5473
Practice Address - Country:US
Practice Address - Phone:308-850-8862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)