Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1235513094 |
---|---|
Provider Name | Lee Higginbotham |
First Address | Lubbock, TX 79411-1820 |
Second Address | Lubbock, TX 79411-1820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2015 |
Last Update Date | 11/07/2015 |