Healthcare Provider Details

I. General information

NPI: 1851463186
Provider Name (Legal Business Name): ANTHONY JOHN HUFFAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 MCMILLAN AVE STE 108
SAN LUIS OBISPO CA
93401-6765
US

IV. Provider business mailing address

2925 MCMILLAN AVE STE 108
SAN LUIS OBISPO CA
93401-6765
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-2266
  • Fax: 805-544-2266
Mailing address:
  • Phone: 805-781-4948
  • Fax: 805-544-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number32206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: