Provider Demographics
NPI:1124747118
Name:MOFFITT-CARNEY, KELSEY (PHD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MOFFITT-CARNEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5013
Mailing Address - Country:US
Mailing Address - Phone:913-651-8415
Mailing Address - Fax:
Practice Address - Street 1:101 E CEDAR ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-4416
Practice Address - Country:US
Practice Address - Phone:913-393-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03174-T103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist