Healthcare Provider Details

I. General information

NPI: 1962634436
Provider Name (Legal Business Name): TYLER CURT HUFFAKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E CENTER ST SUITE 112
LOGAN UT
84321-4664
US

IV. Provider business mailing address

60 E CENTER ST STE 112
LOGAN UT
84321-4659
US

V. Phone/Fax

Practice location:
  • Phone: 435-757-3670
  • Fax: 888-380-4476
Mailing address:
  • Phone: 435-757-3670
  • Fax: 888-380-4476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC13359
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number84160223501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: