Healthcare Provider Details

I. General information

NPI: 1174937411
Provider Name (Legal Business Name): ILEANA SISSON COUNSELING & CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 06/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 COLONIAL BLVD BUILDING F, SUITE 41A
FORT MYERS FL
33907-1013
US

IV. Provider business mailing address

5395 ANCHORAGE DR
SAINT JAMES CITY FL
33956-3052
US

V. Phone/Fax

Practice location:
  • Phone: 239-464-9022
  • Fax:
Mailing address:
  • Phone: 239-283-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2477
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number2477
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number2477
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number2477
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2477
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number2477
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2477
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2477
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2477
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2477
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number2477
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2477
License Number StateFL
# 13
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number2477
License Number StateFL
# 14
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number2477
License Number StateFL
# 15
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2477
License Number StateFL

VIII. Authorized Official

Name: DR. ILEANA SISSON
Title or Position: LICENSED PSYCHOTHERAPIST
Credential: MS PHD
Phone: 239-464-9022