Provider Demographics
NPI:1346250842
Name:DOTSON ALEXANDER, THERESA (LPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:DOTSON ALEXANDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:DOTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5048 NE MARVIN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-5923
Mailing Address - Country:US
Mailing Address - Phone:660-259-3823
Mailing Address - Fax:816-474-4914
Practice Address - Street 1:811A SOUTH HIGHWAY 13
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067
Practice Address - Country:US
Practice Address - Phone:660-259-3823
Practice Address - Fax:660-259-4486
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495043424Medicaid