Individual
BRYAN CORLEY MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
5701 AVENUE P, LUBBOCK, TX 79412-3674
(806) 747-3488
(806) 747-3219
Mailing address
5701 AVENUE P, LUBBOCK, TX 79412-3674
(806) 747-3488
(806) 747-3219
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
12735
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
022779
VMC EAP
TX
05
—
152320101
—
TX
01
—
207800
COMPSYCH EAP
TX
01
—
22100
FIRSTCARE COMMERCIAL
TX
01
—
83479L
BCBS TEXAS
TX
Enumeration date
10/04/2006
Last updated
10/08/2012
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