Provider Demographics
NPI:1922587849
Name:KISER, SCOTT (LMFT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KISER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 COUNTY ROAD 1300 N
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-5010
Mailing Address - Country:US
Mailing Address - Phone:618-382-4164
Mailing Address - Fax:618-382-3239
Practice Address - Street 1:949 COUNTY ROAD 1300 N
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-5010
Practice Address - Country:US
Practice Address - Phone:618-382-4164
Practice Address - Fax:618-382-3239
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.000770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist