Provider Demographics
NPI:1275304941
Name:MOEN, ALEXANDER GRIFFITH (LPC-T)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:GRIFFITH
Last Name:MOEN
Suffix:
Gender:M
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 1ST ST N APT 10
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2723
Mailing Address - Country:US
Mailing Address - Phone:316-737-9942
Mailing Address - Fax:
Practice Address - Street 1:825 N WACO AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3939
Practice Address - Country:US
Practice Address - Phone:316-737-9942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04580-T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health