Individual
DR. CHARLES MICHAEL KISSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, LPC, ICAADC
Contact information
Practice address
4000 E CHARTER OAK RD, GUTHRIE, OK 73044-9350
(405) 466-8155
(405) 390-5668
Mailing address
4000 E CHARTER OAK RD, GUTHRIE, OK 73044-9350
(405) 466-8155
(866) 390-5668
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC04707
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
844
OK
Other
Enumeration date
03/10/2009
Last updated
08/20/2024
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