Healthcare Provider Details

I. General information

NPI: 1477419166
Provider Name (Legal Business Name): EMILY C KISSNER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2025
Last Update Date: 12/27/2025
Certification Date: 12/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HIGHLAND PARK DR
BATON ROUGE LA
70808-5650
US

IV. Provider business mailing address

1055 HIGHLAND PARK DR
BATON ROUGE LA
70808-5650
US

V. Phone/Fax

Practice location:
  • Phone: 312-686-8277
  • Fax:
Mailing address:
  • Phone: 312-686-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180015599
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number180015599
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: