Provider Demographics
NPI:1710509369
Name:KISSACK, ANNE C (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:C
Last Name:KISSACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8749 SOUTHWESTERN BLVD APT 18201
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-2783
Mailing Address - Country:US
Mailing Address - Phone:203-710-1102
Mailing Address - Fax:
Practice Address - Street 1:8749 SOUTHWESTERN BLVD APT 18201
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-2783
Practice Address - Country:US
Practice Address - Phone:203-710-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional