Provider Demographics
NPI:1033307848
Name:HUCKABAY, MARY ALICIA (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICIA
Last Name:HUCKABAY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WALLACE BLVD BLDG 501
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1705
Mailing Address - Country:US
Mailing Address - Phone:806-351-3455
Mailing Address - Fax:
Practice Address - Street 1:901 WALLACE BLVD BLDG 501
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1705
Practice Address - Country:US
Practice Address - Phone:806-351-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional