Healthcare Provider Details

I. General information

NPI: 1386758803
Provider Name (Legal Business Name): MELISSA D. HUFFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W PINE ST
FARMINGTON MO
63640-1403
US

IV. Provider business mailing address

118 W PINE ST
FARMINGTON MO
63640-1403
US

V. Phone/Fax

Practice location:
  • Phone: 573-701-0330
  • Fax: 573-701-0330
Mailing address:
  • Phone: 573-701-0330
  • Fax: 573-701-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2005012306
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: