Healthcare Provider Details

I. General information

NPI: 1861825549
Provider Name (Legal Business Name): MICHAEL THOMAS HUFFMAN M.A..
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4541 ALRIX DR
ORLANDO FL
32839-3160
US

IV. Provider business mailing address

4541 ALRIX DR
ORLANDO FL
32839-3160
US

V. Phone/Fax

Practice location:
  • Phone: 407-489-2121
  • Fax: 407-352-2026
Mailing address:
  • Phone: 407-489-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH5456
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: