Provider Demographics
NPI:1528254729
Name:HUFFMAN PSYCHOLOGY, PLLC
Entity type:Organization
Organization Name:HUFFMAN PSYCHOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-926-8320
Mailing Address - Street 1:4572 S HAGADORN RD
Mailing Address - Street 2:SUITE 2G
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5385
Mailing Address - Country:US
Mailing Address - Phone:517-337-9554
Mailing Address - Fax:517-337-9545
Practice Address - Street 1:4572 S HAGADORN RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5385
Practice Address - Country:US
Practice Address - Phone:517-337-9554
Practice Address - Fax:517-337-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680C312320OtherBCBS OF MI
MI7771OtherACCESS ALLIANCE OF MI
MI01006041OtherHEALTH PLAN OF MICHIGAN
MI200000006961OtherSPHN PHPMM TPA
MI0N86730Medicare PIN