Provider Demographics
NPI:1306283627
Name:DOWELL, MALISSA SUE (LPC)
Entity type:Individual
Prefix:
First Name:MALISSA
Middle Name:SUE
Last Name:DOWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MALISSA
Other - Middle Name:SUE
Other - Last Name:BEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-2712
Mailing Address - Country:US
Mailing Address - Phone:573-682-4476
Mailing Address - Fax:417-944-1440
Practice Address - Street 1:214 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2712
Practice Address - Country:US
Practice Address - Phone:573-682-4476
Practice Address - Fax:417-944-1440
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013013900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490005429Medicaid