Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 63790 | TX |
NPI | 1003105149 |
---|---|
Provider Name | Mr. Brad Stiggers |
First Address | Lubbock, TX 79412-3007 |
Second Address | Lubbock, TX 79412-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |