Provider Demographics
NPI:1144611641
Name:HUXTABLE, KAY
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:HUXTABLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7727
Mailing Address - Country:US
Mailing Address - Phone:530-544-2111
Mailing Address - Fax:
Practice Address - Street 1:2580 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7727
Practice Address - Country:US
Practice Address - Phone:530-544-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health