Healthcare Provider Details

I. General information

NPI: 1457811465
Provider Name (Legal Business Name): DEVIN LANE HUFFMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 CITYVIEW DR
MORGANTOWN WV
26501-7872
US

IV. Provider business mailing address

322 BUTLER DR
MORGANTOWN WV
26508-9229
US

V. Phone/Fax

Practice location:
  • Phone: 304-767-5771
  • Fax:
Mailing address:
  • Phone: 304-767-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-34932
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: