Provider Demographics
NPI:1801076229
Name:HUGHLEY, EUGENE JR
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:HUGHLEY
Suffix:JR
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 1:3253 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3106
Mailing Address - Country:US
Mailing Address - Phone:989-793-4790
Mailing Address - Fax:989-793-1641
Practice Address - Street 1:3253 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3106
Practice Address - Country:US
Practice Address - Phone:989-793-4790
Practice Address - Fax:989-793-1641
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010008791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical