Alec Kissack, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

18915 Issued in TX

Practice address

20415 Gulf Victory Way
Fort Bliss, TX 79918-8066

Phone

(915) 351-2555

Fax

(915) 744-4833

NPI assigned

Nov 14, 2006

Last updated

Nov 2, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centro San Vicente

  • Federally Qualified Health Center (FQHC)
  • El Paso, TX
  • NPI 1841480902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1639241813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20415 GULF VICTORY WAY",
            "city": "FORT BLISS",
            "state": "TX",
            "postal_code": "799188066",
            "telephone_number": "915-217-3314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20415 GULF VICTORY WAY",
            "city": "FORT BLISS",
            "state": "TX",
            "postal_code": "799188066",
            "telephone_number": "915-351-2555",
            "fax_number": "915-744-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSACK",
        "first_name": "ALEC",
        "name_prefix": "Mr.",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "10861",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "18915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "130880107",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MILITARY",
            "identifier": "1639241813",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Kim, MD
• Jessica Kim, DO
• Justin Kimmel
• Derek T Kirby, D.O.
• Owen Kish
• Kirby Stuart Kjar, DMD
• Seth Klusewitz
• Jordan Elizabeth Kopf, DO
• Nathan Edward Kosiba, DDS
• Thomas Kotnik, MD

• Professional Counselor in Fort Bliss, TX
• Providers in Fort Bliss, TX by specialty
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.