Provider Demographics
NPI:1962830919
Name:HUCHTEMAN, DOUGLAS WAYNE
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:WAYNE
Last Name:HUCHTEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4349
Mailing Address - Country:US
Mailing Address - Phone:405-789-3204
Mailing Address - Fax:
Practice Address - Street 1:8007 NW 32ND ST
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-4349
Practice Address - Country:US
Practice Address - Phone:405-789-3204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33793101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK33793OtherEUDD#