Healthcare Provider Details

I. General information

NPI: 1174961650
Provider Name (Legal Business Name): MARILYNN J. HUFFHIBBLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 09/12/2025
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

12021 WILMINGTON AVE
LOS ANGELES CA
90059-3019
US

V. Phone/Fax

Practice location:
  • Phone: 424-222-3372
  • Fax:
Mailing address:
  • Phone: 310-482-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: