Provider Demographics
NPI:1871030809
Name:BRANDT-KESSLER, KATHLEEN (RN, BSN, LMSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BRANDT-KESSLER
Suffix:
Gender:F
Credentials:RN, BSN, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HUNTERS RUN
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6234
Mailing Address - Country:US
Mailing Address - Phone:937-214-5367
Mailing Address - Fax:
Practice Address - Street 1:3401 W TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5752
Practice Address - Country:US
Practice Address - Phone:937-214-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2020-06-09
Deactivation Date:2019-05-22
Deactivation Code:
Reactivation Date:2020-06-09
Provider Licenses
StateLicense IDTaxonomies
MO2012040221101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor