Provider Demographics
NPI:1235513094
Name:HIGGINBOTHAM, LEE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:HIGGINBOTHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 33RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79411-1820
Mailing Address - Country:US
Mailing Address - Phone:806-786-0344
Mailing Address - Fax:
Practice Address - Street 1:1718 33RD ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79411-1820
Practice Address - Country:US
Practice Address - Phone:806-786-0344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral