Healthcare Provider Details

I. General information

NPI: 1235265760
Provider Name (Legal Business Name): LISA PROSSER-DODDS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19401 E US HIGHWAY 40 STE 140
INDEPENDENCE MO
64055-5450
US

IV. Provider business mailing address

19401 E US HIGHWAY 40 STE 140
INDEPENDENCE MO
64055-5450
US

V. Phone/Fax

Practice location:
  • Phone: 816-373-6761
  • Fax: 816-373-6761
Mailing address:
  • Phone: 816-373-6761
  • Fax: 816-373-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMO2130
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMO2130
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: