MEDICARE: MRS. KATHLEEN ANN GISSLER M.A., LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	76808	TX
2	101YP2500X	Professional Counselor	7214	OK

General Provider Information

NPI Number	:	1891231775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN ANN GISSLER M.A., LPC, NCC

Provider Business Mailing Address
First Line	:	11209 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6351
Country	:	US
Telephone Number	:	405-531-0409
Fax Number	:

Provider Business Practice Location Address
First Line	:	11209 N MAY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-6351
Country	:	US
Telephone Number	:	405-531-0409
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	07/06/2019

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