Provider Demographics
NPI:1639380819
Name:HUFFMAN, CLINTON LEVOY III (MFT)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:LEVOY
Last Name:HUFFMAN
Suffix:III
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17401 SMOKEY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8925
Mailing Address - Country:US
Mailing Address - Phone:209-586-3898
Mailing Address - Fax:
Practice Address - Street 1:197 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5163
Practice Address - Country:US
Practice Address - Phone:209-533-3553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist