| Doctor Name: | LAURIE JO MOFFITT |
| NPI Number: | 1043613094 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC |
| License Number: | 178.007184 |
| Business Practice Address: | 111 E Main St St Charles, IL - 601741948 |
| Business Phone Number: | 6305873777 |
| Business Fax Number: | |
| Mailing Address: | 111 E Main St, ST CHARLES |
| State: | IL |
| Postal Code: | 601741948 |
| Phone Number: | 6305873777 |
| Fax Number: | |
| NPI Enumeration Date: | 10/06/2014 |
| NPI Last Update Date: | 11/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178.007184 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |