Provider Demographics
NPI:1760406987
Name:MOORE, DORI E (LSCSW)
Entity Type:Individual
Prefix:
First Name:DORI
Middle Name:E
Last Name:MOORE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:DOROTHEA
Other - Middle Name:E
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCSW
Mailing Address - Street 1:8340 MISSION RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-642-0100
Mailing Address - Fax:913-642-0176
Practice Address - Street 1:8340 MISSION RD
Practice Address - Street 2:SUITE 210
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-642-0100
Practice Address - Fax:913-642-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05121041C0700X
MO0019181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO16782017OtherBLUE SHIELD OF KC
KS625078OtherBLUE SHIELD OF KANSAS
KS0005883Medicare ID - Type Unspecified
MO0005883AMedicare ID - Type Unspecified