Provider Demographics
NPI:1982102661
Name:RISSMAN, KASEY DANIELLE (LPCC)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:DANIELLE
Last Name:RISSMAN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43585 MONTEREY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9398
Mailing Address - Country:US
Mailing Address - Phone:760-777-7720
Mailing Address - Fax:760-452-8532
Practice Address - Street 1:43585 MONTEREY AVE STE 1
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9398
Practice Address - Country:US
Practice Address - Phone:760-777-7720
Practice Address - Fax:760-452-8532
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCC12502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health