Healthcare Provider Details

I. General information

NPI: 1023489598
Provider Name (Legal Business Name): JASMINE HUFFMAN CADTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 1ST ST
EUREKA CA
95501-0840
US

IV. Provider business mailing address

2107 1ST ST
EUREKA CA
95501-0840
US

V. Phone/Fax

Practice location:
  • Phone: 707-268-2990
  • Fax:
Mailing address:
  • Phone: 707-273-6395
  • Fax: 707-442-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: