Individual
MRS. ELISSA DAWN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS LMFT
Contact information
Practice address
555 N WOODLAWN ST STE 102, WICHITA, KS 67208-3671
(316) 652-2590
(316) 652-2595
Mailing address
555 N WOODLAWN ST STE 102, WICHITA, KS 67208-3671
(316) 652-2590
(316) 652-2595
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
878
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098090A
—
KS
Enumeration date
03/27/2007
Last updated
07/29/2010
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