Provider Demographics
NPI:1487821849
Name:MCCLINTON MOORE, LEONE M (AAPS CERTIFICATION)
Entity type:Individual
Prefix:
First Name:LEONE
Middle Name:M
Last Name:MCCLINTON MOORE
Suffix:
Gender:F
Credentials:AAPS CERTIFICATION
Other - Prefix:
Other - First Name:LEONE
Other - Middle Name:M
Other - Last Name:MCCLINTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AAPS CERTIFICATION
Mailing Address - Street 1:3826 E 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-2036
Mailing Address - Country:US
Mailing Address - Phone:316-312-6366
Mailing Address - Fax:
Practice Address - Street 1:3826 E 16TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2036
Practice Address - Country:US
Practice Address - Phone:316-312-6366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)