Provider Demographics
NPI:1154478931
Name:DODDS, ALISA K (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:K
Last Name:DODDS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WESTOWNE ST.
Mailing Address - Street 2:STE 501
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3512
Mailing Address - Country:US
Mailing Address - Phone:816-781-2110
Mailing Address - Fax:816-781-2312
Practice Address - Street 1:5 WESTOWNE ST
Practice Address - Street 2:STE 501
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3512
Practice Address - Country:US
Practice Address - Phone:816-781-2110
Practice Address - Fax:816-781-2312
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022069101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional