Provider Demographics
NPI:1962634436
Name:HUFFAKER, TYLER CURT (LCSW)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CURT
Last Name:HUFFAKER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 E CENTER ST STE 112
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4659
Mailing Address - Country:US
Mailing Address - Phone:435-757-3670
Mailing Address - Fax:888-380-4476
Practice Address - Street 1:60 E CENTER ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4664
Practice Address - Country:US
Practice Address - Phone:435-757-3670
Practice Address - Fax:888-380-4476
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC133591041C0700X
UT841602235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical