Healthcare Provider Details

I. General information

NPI: 1871231225
Provider Name (Legal Business Name): JUSTIN HUFT LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6296 MAGNOLIA AVE # 1062
RIVERSIDE CA
92506-2526
US

IV. Provider business mailing address

PO BOX 231
RIALTO CA
92377-0231
US

V. Phone/Fax

Practice location:
  • Phone: 949-274-9721
  • Fax:
Mailing address:
  • Phone: 949-257-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number107802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: