Provider Demographics
NPI:1407509896
Name:DEDMON, ALLYSSA DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:DENISE
Last Name:DEDMON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALLY
Other - Middle Name:
Other - Last Name:DEDMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3955 S FARM ROAD 223
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8807
Mailing Address - Country:US
Mailing Address - Phone:417-812-4440
Mailing Address - Fax:417-208-5880
Practice Address - Street 1:3955 S FARM ROAD 223
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65742-8807
Practice Address - Country:US
Practice Address - Phone:417-812-4440
Practice Address - Fax:417-208-5880
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019044872101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional