1295592335 NPI number — TRACY JANEL HUFFMAN LMSW

Table of content: TRACY JANEL HUFFMAN LMSW (NPI 1295592335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295592335 NPI number — TRACY JANEL HUFFMAN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUFFMAN
Provider First Name:
TRACY
Provider Middle Name:
JANEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHATWELL
Provider Other First Name:
TRACY
Provider Other Middle Name:
JANEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295592335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 HIGHWAY 71 N STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALMA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72921-5114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-322-9375
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 HIGHWAY 71 N STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALMA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72921-5114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-322-9375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  11234-M , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 11234-C , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)