Provider Demographics
NPI:1386758803
Name:HUFFMAN, MELISSA D (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:D
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1403
Mailing Address - Country:US
Mailing Address - Phone:573-701-0330
Mailing Address - Fax:573-701-0330
Practice Address - Street 1:118 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1403
Practice Address - Country:US
Practice Address - Phone:573-701-0330
Practice Address - Fax:573-701-0330
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050123061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical