Provider Demographics
NPI:1629569249
Name:HUFFMAN, STEPHANIE E
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:HUFFMAN
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 1:590 W HIGHWAY 105 STE 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9125
Mailing Address - Country:US
Mailing Address - Phone:719-649-5037
Mailing Address - Fax:
Practice Address - Street 1:590 W HIGHWAY 105 STE 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9125
Practice Address - Country:US
Practice Address - Phone:719-649-5037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician