Healthcare Provider Details

I. General information

NPI: 1114491362
Provider Name (Legal Business Name): CIARA N. HUOT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2019
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 30TH AVE
GULFPORT MS
39501-2741
US

IV. Provider business mailing address

1601 30TH AVE
GULFPORT MS
39501-2741
US

V. Phone/Fax

Practice location:
  • Phone: 228-284-2644
  • Fax: 855-402-2013
Mailing address:
  • Phone: 228-284-2644
  • Fax: 855-402-2013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-0193
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2650
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: