Individual
SHANA L MCKISSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LAC
Contact information
Practice address
16815 S DESERT FOOTHILLS PKWY STE 134, PHOENIX, AZ 85048-8465
(602) 550-5221
Mailing address
291 N KENNETH PL, CHANDLER, AZ 85226-2944
(480) 309-9335
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC20269
AZ
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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