Provider Demographics
NPI:1033895669
Name:MOORE, GRACE (T-LMSW)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:T-LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10531 W 113TH ST APT 4402
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2288
Mailing Address - Country:US
Mailing Address - Phone:563-265-4010
Mailing Address - Fax:
Practice Address - Street 1:25055 W VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8430
Practice Address - Country:US
Practice Address - Phone:563-265-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13210-T1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical