Provider Demographics
NPI:1679271514
Name:HUFF, JACKLYN TASHA
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:TASHA
Last Name:HUFF
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 1:1845 JONES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BYRDSTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38549-4621
Mailing Address - Country:US
Mailing Address - Phone:931-397-9263
Mailing Address - Fax:
Practice Address - Street 1:301 ZACHARY ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1241
Practice Address - Country:US
Practice Address - Phone:931-823-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician