Provider Demographics
NPI:1013776913
Name:SISSELL, KRISTA ANN (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:ANN
Last Name:SISSELL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8397 N HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886-9530
Mailing Address - Country:US
Mailing Address - Phone:231-823-4470
Mailing Address - Fax:
Practice Address - Street 1:8397 N HOLLAND RD
Practice Address - Street 2:
Practice Address - City:SIX LAKES
Practice Address - State:MI
Practice Address - Zip Code:48886-9530
Practice Address - Country:US
Practice Address - Phone:231-823-4470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511178761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical