Provider Demographics
NPI:1437770997
Name:HUNTINGTON, TED (CPS,CTSS,PASTOR)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:HUNTINGTON
Suffix:
Gender:M
Credentials:CPS,CTSS,PASTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 E CINDY ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5408
Mailing Address - Country:US
Mailing Address - Phone:480-329-9885
Mailing Address - Fax:
Practice Address - Street 1:1443 E CINDY ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5408
Practice Address - Country:US
Practice Address - Phone:480-329-9885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ-405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional