Healthcare Provider Details

I. General information

NPI: 1013829605
Provider Name (Legal Business Name): TAMARA HUDDLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N WALNUT ST
LANSING MI
48933-1126
US

IV. Provider business mailing address

503 N WALNUT ST
LANSING MI
48933-1126
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-2435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451025298
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: