Provider Demographics
NPI:1568909323
Name:HUXFORD, JERRA
Entity Type:Individual
Prefix:
First Name:JERRA
Middle Name:
Last Name:HUXFORD
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:P.O. BOX 188
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357
Mailing Address - Country:US
Mailing Address - Phone:937-465-0010
Mailing Address - Fax:
Practice Address - Street 1:3454 OAK ALLEY COURT
Practice Address - Street 2:SUITE 308
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-724-0276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2018-09-12
Deactivation Date:2017-08-29
Deactivation Code:
Reactivation Date:2018-09-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor