Provider Demographics
NPI:1609304195
Name:HUDDLESTON, GALE D (MED)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:D
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 ZEPHYR GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7090
Mailing Address - Country:US
Mailing Address - Phone:773-742-2922
Mailing Address - Fax:
Practice Address - Street 1:3414 ZEPHYR GLEN WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7090
Practice Address - Country:US
Practice Address - Phone:773-742-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDIAGNOSTCIAN171M00000X
174H00000X
TXDIGNOSTICIAN103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator