Provider Demographics
NPI:1417052614
Name:MOFFITT, WILLIAM ALBERT (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALBERT
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18955 WEST 116TH STREET
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061
Mailing Address - Country:US
Mailing Address - Phone:913-888-2362
Mailing Address - Fax:
Practice Address - Street 1:3515 S 4TH STREET
Practice Address - Street 2:PROFESSIONAL ASSOCIATION
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-651-8415
Practice Address - Fax:913-772-8580
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS675103T00000X
MOR0333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS19924039OtherBCBS OF KC KS
KS004517OtherGROUP BCBS
2008188OtherCIGNA
KS066956OtherBCBS OF KS
WIB011OtherPHYSICIAN SERVICES TRICAR
4285605OtherAETNA
S46674Medicare UPIN
4285605OtherAETNA
KS19924039OtherBCBS OF KC KS