Provider Demographics
NPI:1609199975
Name:HUFFORD, MARK TODD (CADC-II)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:TODD
Last Name:HUFFORD
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11823 SKYLARK ST
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-2028
Mailing Address - Country:US
Mailing Address - Phone:323-496-1279
Mailing Address - Fax:760-288-3752
Practice Address - Street 1:11823 SKYLARK ST
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-2028
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAA3826500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator