Healthcare Provider Details

I. General information

NPI: 1346558954
Provider Name (Legal Business Name): STAN E. HUFF ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TURTLEBACK CT
BLOOMINGTON IL
61705-6301
US

IV. Provider business mailing address

3 TURTLEBACK CT
BLOOMINGTON IL
61705-6301
US

V. Phone/Fax

Practice location:
  • Phone: 309-242-4833
  • Fax:
Mailing address:
  • Phone: 309-242-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number29363
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number166 000482
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: