Healthcare Provider Details

I. General information

NPI: 1144703547
Provider Name (Legal Business Name): ELIZABETH ANNE MOFFITT LMHC, LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 E 1055TH RD
BALDWIN CITY KS
66006-7287
US

IV. Provider business mailing address

793 E 1055TH RD
BALDWIN CITY KS
66006-7287
US

V. Phone/Fax

Practice location:
  • Phone: 913-424-6230
  • Fax:
Mailing address:
  • Phone: 913-424-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLYH61179320
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03854
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number03854
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: