Healthcare Provider Details

I. General information

NPI: 1376495309
Provider Name (Legal Business Name): ALISSA GOERTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N DELAWARE ST
BUTLER MO
64730-1508
US

IV. Provider business mailing address

408 N DELAWARE ST
BUTLER MO
64730-1508
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1376495309
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: