Healthcare Provider Details

I. General information

NPI: 1306283627
Provider Name (Legal Business Name): MALISSA SUE DOWELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALISSA SUE BEASLEY

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 W JACKSON ST
MEXICO MO
65265-2712
US

IV. Provider business mailing address

214 W JACKSON ST
MEXICO MO
65265-2712
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-4476
  • Fax: 417-944-1440
Mailing address:
  • Phone: 573-682-4476
  • Fax: 417-944-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013013900
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: