MEDICARE: MS. SHAN LONG-MOORE M.A., PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2005041422	MO

General Provider Information

NPI Number	:	1851410963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAN LONG-MOORE M.A., PLPC

Provider Business Mailing Address
First Line	:	8530 W 108TH PL
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-1605
Country	:	US
Telephone Number	:	913-302-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	4010 WASHINGTON ST
Second Line	:	SUITE 401
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-2609
Country	:	US
Telephone Number	:	816-561-2374
Fax Number	:	816-561-2374

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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