Healthcare Provider Details

I. General information

NPI: 1487220422
Provider Name (Legal Business Name): EDUARDO HUERTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 05/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S ARDMORE AVE
ADDISON IL
60101-6500
US

IV. Provider business mailing address

111 N COUNTY FARM RD
WHEATON IL
60187-3977
US

V. Phone/Fax

Practice location:
  • Phone: 630-221-2768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: