MEDICARE: DAVID S SISSAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	2025040327	MO

General Provider Information

NPI Number	:	1619546058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID S SISSAC

Provider Business Mailing Address
First Line	:	2420 TEAKWOOD MANOR DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-4436
Country	:	US
Telephone Number	:	314-933-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	6746 ETZEL AVE
Second Line	:
City	:	UNIVERSITY CITY
State	:	MO
Zip	:	63130-2427
Country	:	US
Telephone Number	:	314-206-3900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	01/21/2026

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Directions to “ DAVID S SISSAC ” Practice Location

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