Healthcare Provider Details

I. General information

NPI: 1003653635
Provider Name (Legal Business Name): ALYSSA POTTS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA MCCLOUD

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 TROY SQ
TROY MO
63379-3227
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 660-885-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026022870
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: