Healthcare Provider Details

I. General information

NPI: 1992974646
Provider Name (Legal Business Name): CHRIS M HUFF LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 LELIA DR STE 105
JACKSON MS
39216
US

IV. Provider business mailing address

1755 LELIA DR STE 105
JACKSON MS
39216-4828
US

V. Phone/Fax

Practice location:
  • Phone: 601-209-6345
  • Fax:
Mailing address:
  • Phone: 601-209-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC5077
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: