Provider Demographics
NPI:1881214849
Name:HUCKABA, LINDSAY LAVON (MS, LMFT)
Entity type:Individual
Prefix:MS
First Name:LINDSAY
Middle Name:LAVON
Last Name:HUCKABA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 W 118TH ST APT 61
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1012
Mailing Address - Country:US
Mailing Address - Phone:541-623-0418
Mailing Address - Fax:
Practice Address - Street 1:352 W 118TH ST APT 61
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1012
Practice Address - Country:US
Practice Address - Phone:541-623-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY002109106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor