Charles Michael Kissick, LADC, LPC, ICAADC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

LPC04707 Issued in OK

Practice address

4000 E Charter Oak Rd
Guthrie, OK 73044-9350

Phone

(405) 466-8155

Fax

(405) 390-5668

NPI assigned

Mar 10, 2009

Last updated

Aug 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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.

• Abundant Life Today Services, LLC

  • Community/Behavioral Health Agency
  • Guthrie, OK
  • NPI 1447657929
  NPD (past) Authorized official

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

{
    "created_epoch": "1236643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1972744639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 E CHARTER OAK RD",
            "city": "GUTHRIE",
            "state": "OK",
            "postal_code": "730449350",
            "telephone_number": "405-466-8155",
            "fax_number": "866-390-5668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 E CHARTER OAK RD",
            "city": "GUTHRIE",
            "state": "OK",
            "postal_code": "730449350",
            "telephone_number": "405-466-8155",
            "fax_number": "405-390-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSICK",
        "first_name": "CHARLES",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "LADC, LPC, ICAADC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-03-10",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OK",
            "license": "844",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OK",
            "license": "LPC04707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vanessa M Jones, RN,MINISTER,HERBALIS
• Bobbie Jordan
• Jerry J. Jordan, ED.D., CTRS
• Houston Christopher Joy, APRN
• Sycheekia D King
• Karen Lynn Kissick, CASE MANAGER
• Christopher S Koenig, DPH
• Kimberly Kysar, M.S., CCC-SLP
• L.C.a.R.C.,Inc (New Horizons)
• John Douglas Lassiter, D.PH.

• Counselor in Guthrie, OK
• Providers in Guthrie, OK by specialty
• Counselor in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; 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.