Individual
JUANITA M KISSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC, NCC, CCMHC
Contact information
Practice address
1003 BIRCH LN, PORTLAND, TN 37148-6027
(615) 878-4058
Mailing address
1003 BIRCH LN, PORTLAND, TN 37148-6027
(615) 878-4058
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC2686
TN
101YP2500X
Professional Counselor
LPC00545
MN
101YP2500X
Professional Counselor
LPCC1290
KY
Other
Enumeration date
09/30/2010
Last updated
11/18/2015
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