Provider Demographics
NPI:1982240305
Name:BROWN, ALYSSA JENE' (LPC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JENE'
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7707
Mailing Address - Country:US
Mailing Address - Phone:573-222-0096
Mailing Address - Fax:573-240-8433
Practice Address - Street 1:151 SOUTH MAIN STREET, SUITE B
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-6364
Practice Address - Country:US
Practice Address - Phone:573-561-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017042457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional