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General NPI Number Information
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NPI Number | 1851410963
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Entity Type | Individual
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Provider Name | SHAN LONG-MOORE M.A., PLPC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4010 WASHINGTON ST SUITE 401
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City | KANSAS CITY
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State | MO
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Zip | 64111-2609
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Country | US
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Telephone | 816-561-2374
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Fax | 816-561-2374
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Provider Business Mailing Address
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Address Line | 8530 W 108TH PL
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City | OVERLAND PARK
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State | KS
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Zip | 66210-1605
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Country | US
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Telephone | 913-302-8227
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2005041422
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License Number State | MO
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