Healthcare Provider Details

I. General information

NPI: 1053392415
Provider Name (Legal Business Name): DONNELL R HUFF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNELL GATSON

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 WELLER ST
MACON MO
63552-1942
US

IV. Provider business mailing address

303 WELLER ST
MACON MO
63552-1942
US

V. Phone/Fax

Practice location:
  • Phone: 660-395-0180
  • Fax: 660-395-0181
Mailing address:
  • Phone: 660-395-0180
  • Fax: 660-395-0181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2002021129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: