Provider Information for 1750679122
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PAMELA DIANE HUCKABY LCSW
Other Names:Former Name:PAMELA DIANE LEAVENWORTHSex: Female
NPI: 1750679122
Last Updated: 2019-04-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1750679122 | ||||||||
| Enumeration Date | 2011-07-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 663 W 950 S BRIGHAM CITY, UT 84302-3021 United States Phone: 435-734-9449 | Fax:435-723-4851 | ||||||||
| Primary Practice Address | 663 W 950 S BRIGHAM CITY, UT 84302-3021 United States Phone: 435-734-9449 | Fax:435-723-4851 | ||||||||
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