Provider Demographics
NPI:1962828434
Name:LAURIE MOFFITT, LSCSW, LLC
Entity Type:Organization
Organization Name:LAURIE MOFFITT, LSCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAURETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:316-831-0999
Mailing Address - Street 1:1999 N AMIDON AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2121
Mailing Address - Country:US
Mailing Address - Phone:316-831-0999
Mailing Address - Fax:316-831-0998
Practice Address - Street 1:1999 N AMIDON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2121
Practice Address - Country:US
Practice Address - Phone:316-831-0999
Practice Address - Fax:316-831-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS42981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty