Healthcare Provider Details

I. General information

NPI: 1982107546
Provider Name (Legal Business Name): REGINA HUFFMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2018
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S FIRST ST
GALLUP NM
87301-6211
US

IV. Provider business mailing address

303 S FIRST ST
GALLUP NM
87301-6211
US

V. Phone/Fax

Practice location:
  • Phone: 505-870-4982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0127231
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: