Healthcare Provider Details

I. General information

NPI: 1780175802
Provider Name (Legal Business Name): LAUREL HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 WHITES RD STE 4
KALAMAZOO MI
49008-2883
US

IV. Provider business mailing address

11646 E O AVE
CLIMAX MI
49034-9723
US

V. Phone/Fax

Practice location:
  • Phone: 866-232-5389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401015032
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: