Provider Demographics
NPI:1609550227
Name:VASSAR, JOSHALYNN M (BSW, MS, PLPC)
Entity Type:Individual
Prefix:
First Name:JOSHALYNN
Middle Name:M
Last Name:VASSAR
Suffix:
Gender:F
Credentials:BSW, MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 SW 1971ST RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64061-9253
Mailing Address - Country:US
Mailing Address - Phone:816-405-0295
Mailing Address - Fax:
Practice Address - Street 1:616 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1462
Practice Address - Country:US
Practice Address - Phone:660-747-7127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023022616101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2023022616OtherPROVISIONAL LICENSE PROFESSIONAL COUNSELOR