Provider Demographics
NPI:1033408877
Name:HUNTLEY, MARTIN (CADC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:HUNTLEY
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 1ST AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-1765
Mailing Address - Country:US
Mailing Address - Phone:815-626-2800
Mailing Address - Fax:
Practice Address - Street 1:707 1ST AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-1765
Practice Address - Country:US
Practice Address - Phone:815-626-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-5286-0002-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)