Healthcare Provider Details

I. General information

NPI: 1538836283
Provider Name (Legal Business Name): AMANDA N HUDDLESTON M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SOUTHPARK CENTER DR STE 5
CORBIN KY
40701-8312
US

IV. Provider business mailing address

37 SOUTHPARK CENTER DR STE 5
CORBIN KY
40701-8312
US

V. Phone/Fax

Practice location:
  • Phone: 606-261-4308
  • Fax:
Mailing address:
  • Phone: 606-404-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number306986
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: