Healthcare Provider Details

I. General information

NPI: 1538283411
Provider Name (Legal Business Name): CHRISTINE B CISSNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 NE VIVION RD STE 204
KANSAS CITY MO
64119-2800
US

IV. Provider business mailing address

514 N PLEASANT ST
INDEPENDENCE MO
64050-2660
US

V. Phone/Fax

Practice location:
  • Phone: 816-803-4944
  • Fax:
Mailing address:
  • Phone: 816-803-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002697
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: