Provider Demographics
NPI:1891917324
Name:MOORE, KEVIN P (LCMFT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:P
Last Name:MOORE
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W 13TH ST N STE 9
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2968
Mailing Address - Country:US
Mailing Address - Phone:316-721-8118
Mailing Address - Fax:316-721-8139
Practice Address - Street 1:7200 W 13TH ST N STE 9
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2968
Practice Address - Country:US
Practice Address - Phone:316-721-8118
Practice Address - Fax:316-721-8139
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist