Healthcare Provider Details

I. General information

NPI: 1215794375
Provider Name (Legal Business Name): NICOLE KELLY HUFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MILL ST
RENO NV
89502-1321
US

IV. Provider business mailing address

10590 EAGLE FALLS WAY
RENO NV
89521-4164
US

V. Phone/Fax

Practice location:
  • Phone: 775-954-1400
  • Fax:
Mailing address:
  • Phone: 775-762-3885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07708-I
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: