Provider Demographics
NPI:1982789053
Name:RAFFERTY, MOLLY (LPC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7433
Mailing Address - Country:US
Mailing Address - Phone:806-468-8900
Mailing Address - Fax:806-468-8902
Practice Address - Street 1:912 CLYDE ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4206
Practice Address - Country:US
Practice Address - Phone:806-468-8900
Practice Address - Fax:806-468-8902
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11914101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional