Provider Demographics
NPI:1417024407
Name:HUISKEN, TODD (MFT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:
Last Name:HUISKEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17350 MOUNT HERRMANN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4114
Mailing Address - Country:US
Mailing Address - Phone:714-444-3463
Mailing Address - Fax:714-444-1768
Practice Address - Street 1:17350 MOUNT HERRMANN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4114
Practice Address - Country:US
Practice Address - Phone:714-444-3463
Practice Address - Fax:714-444-1768
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC34358OtherLICENSE NUMBER