Healthcare Provider Details

I. General information

NPI: 1871864322
Provider Name (Legal Business Name): KANISHA MOYE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2012
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10612 VORHOF DR
SAINT LOUIS MO
63136-5730
US

IV. Provider business mailing address

10612 VORHOF DR
SAINT LOUIS MO
63136-5730
US

V. Phone/Fax

Practice location:
  • Phone: 314-332-7657
  • Fax:
Mailing address:
  • Phone: 314-332-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2021012423
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: