Provider Demographics
NPI:1497479208
Name:MOORE, STEPHANIE LYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYN
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:STEVIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:830 BEACON PKWY E APT D
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3254
Mailing Address - Country:US
Mailing Address - Phone:205-821-7052
Mailing Address - Fax:
Practice Address - Street 1:826 1/2 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2658
Practice Address - Country:US
Practice Address - Phone:785-979-7937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5940G104100000X
KS12823104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker