Provider Demographics
NPI:1982048401
Name:JOUBERT, KISSANDRA RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:KISSANDRA
Middle Name:RENEE
Last Name:JOUBERT
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 1:2923 ROCCO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8742
Mailing Address - Country:US
Mailing Address - Phone:817-793-7315
Mailing Address - Fax:817-468-4744
Practice Address - Street 1:2923 ROCCO DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8742
Practice Address - Country:US
Practice Address - Phone:817-793-7315
Practice Address - Fax:817-468-4744
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66919101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health