Healthcare Provider Details

I. General information

NPI: 1093587701
Provider Name (Legal Business Name): KAELIE CHANCE HUFF MFA-I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S CENTER ST
RENO NV
89501-2319
US

IV. Provider business mailing address

PO BOX 10105
RENO NV
89510-0105
US

V. Phone/Fax

Practice location:
  • Phone: 775-440-1256
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMI4284
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: