Provider Demographics
NPI:1831372325
Name:MOSES, NANCY L (LSCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:MOSES
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MASSCHT ST # 104
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2345
Mailing Address - Country:US
Mailing Address - Phone:785-979-9581
Mailing Address - Fax:785-856-6006
Practice Address - Street 1:719 MASSCHT ST # 104
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2345
Practice Address - Country:US
Practice Address - Phone:785-979-9581
Practice Address - Fax:785-856-6006
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS564101YA0400X
KS42111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200537790CMedicaid