1972076651 NPI number — DR. ELSIE ELIZABETH HUEFNER PHD, CMHC, NCC, DE

Table of content: (NPI 1457315012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972076651 NPI number — DR. ELSIE ELIZABETH HUEFNER PHD, CMHC, NCC, DE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUEFNER
Provider First Name:
ELSIE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, CMHC, NCC, DE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972076651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6375 S HIGHLAND DR # 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLADAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-6561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-618-5243
Provider Business Mailing Address Fax Number:
800-859-6928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6375 S HIGHLAND DR STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLADAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84121-6561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-618-5243
Provider Business Practice Location Address Fax Number:
800-859-6928
Provider Enumeration Date:
01/06/2019

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: 101YM0800X , with the licence number:  320042-6004 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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