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General NPI Number Information
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NPI Number | 1568152189
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Entity Type | Organization
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Legal Business Name | MICHAEL KESSLER PSYD
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 4481 ASH GROVE DR
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City | SPRINGFIELD
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State | IL
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Zip | 62711-6358
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Country | US
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Telephone | 217-751-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 3509 CARNOUSTIE DR
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City | SPRINGFIELD
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State | IL
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Zip | 62712-5548
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Country | US
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Telephone | 217-751-8995
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL KESSLER
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Credential | PSYD
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Telephone | 217-751-8995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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