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General NPI Number Information
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NPI Number | 1225300759
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Entity Type | Individual
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Provider Name | KELLY ANN CISSELL
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Gender | Female
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Dates
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Enumeration Date | 01/30/2012
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 227 E MAIN ST
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City | FESTUS
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State | MO
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Zip | 63028-1952
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Country | US
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Telephone | 636-931-2700
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Fax | 636-296-1961
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Provider Business Mailing Address
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Address Line | 21 MUNICIPAL DR
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City | ARNOLD
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State | MO
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Zip | 63010-1012
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Country | US
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Telephone | 636-296-6206
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Fax | 636-296-0102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2007035677
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License Number State | MO
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