Provider Demographics
NPI:1538509609
Name:HUFF, ERICK (BA)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:HUFF
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1727
Mailing Address - Country:US
Mailing Address - Phone:405-749-8487
Mailing Address - Fax:
Practice Address - Street 1:12509 SPRINGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73120-1727
Practice Address - Country:US
Practice Address - Phone:405-749-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$Medicaid