Individual
GARY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
T-LPC
Contact information
Practice address
350 S BROADWAY AVE, WICHITA, KS 67202-4304
(316) 660-9600
(316) 660-9660
Mailing address
271 W 3RD ST N STE 600, WICHITA, KS 67202-1223
(316) 660-7600
(316) 941-5075
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3313
KS
Other
Enumeration date
10/18/2018
Last updated
10/18/2018
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