Healthcare Provider Details

I. General information

NPI: 1801725957
Provider Name (Legal Business Name): CAROLINE HUCKEBA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 FAIRWAY DR STE 101
DEERFIELD BEACH FL
33441-1834
US

IV. Provider business mailing address

1883 PRAIRIE DOG RUN
RICHARDSON TX
75080-3455
US

V. Phone/Fax

Practice location:
  • Phone: 877-418-2978
  • Fax:
Mailing address:
  • Phone: 972-589-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: