Provider Demographics
NPI:1437037538
Name:YODER, ALYSSA LEEANN
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LEEANN
Last Name:YODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8595 CARTER ROUTE B
Mailing Address - Street 2:
Mailing Address - City:GRANDIN
Mailing Address - State:MO
Mailing Address - Zip Code:63943-9403
Mailing Address - Country:US
Mailing Address - Phone:573-631-1709
Mailing Address - Fax:
Practice Address - Street 1:2153 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2439
Practice Address - Country:US
Practice Address - Phone:573-707-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025035848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health