Healthcare Provider Details

I. General information

NPI: 1326082819
Provider Name (Legal Business Name): BRENDA HUCKABY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FRAZIER AVE
COLUMBIA KY
42728-1915
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-4710
  • Fax: 270-384-4820
Mailing address:
  • Phone: 606-679-4782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3000
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: