Healthcare Provider Details

I. General information

NPI: 1205766029
Provider Name (Legal Business Name): LARON MOORE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 E MAINSGATE RD
WICHITA KS
67226-1062
US

IV. Provider business mailing address

7019 CHAPARRAL ST
VALLEY CENTER KS
67147-8402
US

V. Phone/Fax

Practice location:
  • Phone: 316-461-7923
  • Fax:
Mailing address:
  • Phone: 417-631-5334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05388
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: