Provider Demographics
NPI:1205150505
Name:HUFFMAN, LUKE J (MA)
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:J
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 HOBBS DR
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-2027
Mailing Address - Country:US
Mailing Address - Phone:877-666-7223
Mailing Address - Fax:
Practice Address - Street 1:1550 HOBBS DR
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-2027
Practice Address - Country:US
Practice Address - Phone:877-666-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1089106H00000X
CAMFT 78376171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100061981Medicaid