Healthcare Provider Details

I. General information

NPI: 1689013211
Provider Name (Legal Business Name): A.D. HUFFMAN J.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 W CADDO ST
MARLOW OK
73055-5036
US

IV. Provider business mailing address

PO BOX 332
MARLOW OK
73055-0332
US

V. Phone/Fax

Practice location:
  • Phone: 405-414-8938
  • Fax:
Mailing address:
  • Phone: 405-414-8938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: