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General NPI Number Information
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NPI Number | 1578808499
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Entity Type | Individual
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Provider Name | CORRINE LYNN KISSELLE M.ED, PCC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/08/2012
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Provider Practice Location Address
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Address Line | 24800 HIGHPOINT RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-6052
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Country | US
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Telephone | 216-831-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 192 FOREST HILL DR
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City | AVON LAKE
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State | OH
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Zip | 44012-1744
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Country | US
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Telephone | 440-315-4695
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0900196
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License Number State | OH
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