Active NPI
Anne C Kissack, LPC
- Professional Counselor
- Dallas, TX
National Provider Identifier
1710509369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 78091
- Practice address
- 8749 Southwestern Blvd Apt 18201
Dallas, TX 75206-2783 - Phone
- (203) 710-1102
- NPI assigned
- May 16, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 78091 | TX | Primary |
Addresses
Primary practice location
8749 Southwestern Blvd Apt 18201
Dallas, TX 75206-2783
Mailing address
8749 Southwestern Blvd Apt 18201
Dallas, TX 75206-2783
Phone (203) 710-1102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 28, 2025 through Apr 28, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78091 | TX | MD | Professional Counselor |
| 5151 | CT | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589587200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589587200000",
"number": "1710509369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8749 SOUTHWESTERN BLVD APT 18201",
"city": "DALLAS",
"state": "TX",
"postal_code": "752062783",
"telephone_number": "203-710-1102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8749 SOUTHWESTERN BLVD APT 18201",
"city": "DALLAS",
"state": "TX",
"postal_code": "752062783",
"telephone_number": "203-710-1102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KISSACK",
"first_name": "ANNE",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-16",
"last_updated": "2020-05-16",
"certification_date": "2020-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "78091",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.