Provider Demographics
NPI:1669176558
Name:ETHELL, ANITA JOY HUFFAKER
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:JOY HUFFAKER
Last Name:ETHELL
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 1:355 MILLER ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4247
Mailing Address - Country:US
Mailing Address - Phone:971-719-8132
Mailing Address - Fax:
Practice Address - Street 1:355 MILLER ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4247
Practice Address - Country:US
Practice Address - Phone:971-719-8132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health