1336290279 NPI number — MRS. KAY LYNNE MORAN MSW, LCSW, CCM

Table of content: MRS. KAY LYNNE MORAN MSW, LCSW, CCM (NPI 1336290279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336290279 NPI number — MRS. KAY LYNNE MORAN MSW, LCSW, CCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORAN
Provider First Name:
KAY
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW, CCM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHELL
Provider Other First Name:
KAY
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW, LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336290279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MARSHALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONNELLSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-365-0254
Provider Business Mailing Address Fax Number:
304-368-5346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WELLSPRING FAMILY SERVICES
Provider Second Line Business Practice Location Address:
827 FAIRMONT RD SUITE 201
Provider Business Practice Location Address City Name:
WESTOVER
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-292-1716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CP00938927 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0115071000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".