Provider Demographics
NPI:1568262012
Name:SMITH, ALYSSA NICOLE
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:NICOLE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:ALYSSA
Other - Middle Name:NICOLE
Other - Last Name:FRENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:116 W SHERMAN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9022
Mailing Address - Country:US
Mailing Address - Phone:417-298-0984
Mailing Address - Fax:
Practice Address - Street 1:116 W SHERMAN WAY STE 1
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9022
Practice Address - Country:US
Practice Address - Phone:417-298-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-25-419749106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician