Provider Demographics
NPI:1841626892
Name:MARLOW, ALISSA KAE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:KAE
Last Name:MARLOW
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MISS
Other - First Name:ALISSA
Other - Middle Name:KAE
Other - Last Name:BECHTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCABA
Mailing Address - Street 1:10176 CORPORATE SQUARE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2924
Mailing Address - Country:US
Mailing Address - Phone:314-432-6200
Mailing Address - Fax:
Practice Address - Street 1:918 BERNADETTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5007
Practice Address - Country:US
Practice Address - Phone:573-874-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013034275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst