Kristy Jo Lis, PLPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

8626 Airways Blvd
Southaven, MS 38671-2603

Phone

(662) 772-5937

Fax

(662) 772-5940

NPI assigned

Apr 4, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Desoto Family Counseling Center PLLC

  • Community/Behavioral Health Agency
  • Southaven, MS
  • NPI 1912214792

  Professional

  NPD

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

{
    "created_epoch": "1365033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1811230113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "805-294-3180",
            "fax_number": "662-772-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8626 AIRWAYS BLVD",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712603",
            "telephone_number": "662-772-5937",
            "fax_number": "662-772-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIS",
        "first_name": "KRISTY",
        "middle_name": "JO",
        "credential": "PLPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-04",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristy@desotofamilycounseling.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Desoto Family Counseling Center, PLLC",
            "address_1": "8626 Airways Blvd",
            "city": "Southaven",
            "state": "MS",
            "country_code": "US",
            "postal_code": "386712603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Professional Counselor in Southaven, MS
• Providers in Southaven, MS by specialty
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.