Individual
MRS. KELLY J MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSCSW, LAC
Contact information
Practice address
1126 S CLIFTON AVE, WICHITA, KS 67218-2913
(316) 208-5220
Mailing address
1126 S. CLIFTON AVE., WICHITA, KS 67218-2913
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06496
KS
Other
Enumeration date
07/23/2024
Last updated
07/23/2024
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