Provider Demographics
NPI:1851714810
Name:GISSE, LY
Entity Type:Individual
Prefix:MRS
First Name:LY
Middle Name:
Last Name:GISSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 JOHN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3345
Mailing Address - Country:US
Mailing Address - Phone:831-784-0153
Mailing Address - Fax:831-784-0715
Practice Address - Street 1:201 JOHN ST STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3345
Practice Address - Country:US
Practice Address - Phone:831-784-0153
Practice Address - Fax:831-784-0715
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health