Provider Demographics
NPI:1386953933
Name:MOFFITT, LAURETTA JEAN (LSCSW)
Entity type:Individual
Prefix:MRS
First Name:LAURETTA
Middle Name:JEAN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:MOFFITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1999 N AMIDON AVE
Mailing Address - Street 2:
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:316-831-0999
Practice Address - Street 1:1999 N AMIDON AVE
Practice Address - Street 2:
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:316-831-0999
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS42981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical