Healthcare Provider Details

I. General information

NPI: 1295426377
Provider Name (Legal Business Name): DEBRA HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA NICOLE FISHER - PALMER

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 05/18/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E STATE HIGHWAY 114 STE 160
SOUTHLAKE TX
76092-5261
US

IV. Provider business mailing address

950 E STATE HIGHWAY 114 STE 160
SOUTHLAKE TX
76092-5261
US

V. Phone/Fax

Practice location:
  • Phone: 817-891-9083
  • Fax: 888-403-6922
Mailing address:
  • Phone: 817-891-9083
  • Fax: 888-403-6922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22-232323
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: