Provider Demographics
NPI:1093818809
Name:MOORE, JUNE E (LSCSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JUNE
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:MISS
Other - First Name:JUNE
Other - Middle Name:E
Other - Last Name:COLFLESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:4070 DELP MAIL STOP 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-1300
Mailing Address - Fax:913-588-1310
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:4070 DELP MAIL STOP 4017
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-1300
Practice Address - Fax:913-588-1310
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS22941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO34012011OtherBCBS KANSAS CITY
P00261710OtherRAILROAD MEDICARE
P25538Medicare UPIN
P00261710OtherRAILROAD MEDICARE