Provider Demographics
NPI:1689193997
Name:SISU THERAPY & CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:SISU THERAPY & CONSULTING SERVICES, PLLC
Other - Org Name:KATHRYN PAIGE JAGGERS, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:JAGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-538-4665
Mailing Address - Street 1:1401 MALVERN AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-6378
Mailing Address - Country:US
Mailing Address - Phone:501-538-4665
Mailing Address - Fax:
Practice Address - Street 1:1401 MALVERN AVE STE 140
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6378
Practice Address - Country:US
Practice Address - Phone:501-538-4665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2569-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty