Healthcare Provider Details

I. General information

NPI: 1770415762
Provider Name (Legal Business Name): JONATHAN M. HUFF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 N STATE ST STE 201C
JACKSON MS
39216-3129
US

IV. Provider business mailing address

299 WOOD DALE DR
JACKSON MS
39216-3510
US

V. Phone/Fax

Practice location:
  • Phone: 601-942-3102
  • Fax:
Mailing address:
  • Phone: 601-942-3102
  • Fax: 855-795-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: REBECCA GREEN
Title or Position: BILLING MANAGER
Credential:
Phone: 601-757-2495