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General NPI Number Information
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NPI Number | 1932033677
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Entity Type | Organization
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Legal Business Name | DUSTIN KIESCHNICK, PSYD
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Dates
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Enumeration Date | 06/09/2026
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Last Update Date | 06/09/2026
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Provider Practice Location Address
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Address Line | 497 TAHOE KEYS BLVD APT 35
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3841
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Country | US
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Telephone | 910-467-3217
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Fax |
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Provider Business Mailing Address
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Address Line | 497 TAHOE KEYS BLVD APT 35
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3841
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Country | US
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Telephone | 910-467-3217
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DUSTIN KIESCHNICK
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Credential | PSYD
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Telephone | 530-208-5714
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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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