Provider Demographics
NPI:1346603164
Name:MOFFETT, ADRIS (LMSW)
Entity Type:Individual
Prefix:
First Name:ADRIS
Middle Name:
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-0414
Mailing Address - Country:US
Mailing Address - Phone:682-250-0988
Mailing Address - Fax:682-318-1161
Practice Address - Street 1:90 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5926
Practice Address - Country:US
Practice Address - Phone:318-238-3197
Practice Address - Fax:318-238-3199
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12707104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721442261Medicaid