Provider Demographics
NPI:1649386491
Name:HUCKABY, MICHELE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:HUCKABY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:FORT STOCKTON
Mailing Address - State:TX
Mailing Address - Zip Code:79735-0447
Mailing Address - Country:US
Mailing Address - Phone:432-336-9846
Mailing Address - Fax:432-336-8361
Practice Address - Street 1:204 N. OKLAHOMA
Practice Address - Street 2:
Practice Address - City:FORT STOCKTON
Practice Address - State:TX
Practice Address - Zip Code:79735
Practice Address - Country:US
Practice Address - Phone:432-336-9846
Practice Address - Fax:432-336-8361
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3324LCOtherBCBS PROVIDER ID