Provider Demographics
NPI:1891273934
Name:CARLISLE, ALYSSA ANN (MSCP, LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MSCP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2614
Mailing Address - Country:US
Mailing Address - Phone:816-309-7106
Mailing Address - Fax:
Practice Address - Street 1:200 NE MISSOURI RD STE 200
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4722
Practice Address - Country:US
Practice Address - Phone:816-406-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017031116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty