Healthcare Provider Details

I. General information

NPI: 1558284117
Provider Name (Legal Business Name): RAUL AYALA MORALES LMLP-T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 SHAWNEE RD
KANSAS CITY KS
66103-1236
US

IV. Provider business mailing address

612 SHAWNEE RD
KANSAS CITY KS
66103-1236
US

V. Phone/Fax

Practice location:
  • Phone: 913-379-2007
  • Fax:
Mailing address:
  • Phone: 913-379-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03535-T
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: