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General NPI Number Information
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NPI Number | 1679469290
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Entity Type | Organization
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Legal Business Name | DRAGONFLY THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 240 CEDAR RIDGE RD
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City | LONGVIEW
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State | TX
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Zip | 75602-6706
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Country | US
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Telephone | 936-229-0031
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Fax |
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Provider Business Mailing Address
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Address Line | 240 CEDAR RIDGE RD
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City | LONGVIEW
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State | TX
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Zip | 75602-6706
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Country | US
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Telephone | 936-229-0031
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LARA JANE COFFEY
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Credential | LPC
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Telephone | 936-229-0031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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