Individual
KELLI RAE MIESSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., LPC
Contact information
Practice address
9500 E 63RD ST STE 108, RAYTOWN, MO 64133-4951
(816) 960-7111
Mailing address
5520 LANE AVE, RAYTOWN, MO 64133-3254
(816) 516-6593
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2003030550
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499095701
—
MO
Enumeration date
06/03/2006
Last updated
12/05/2022
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