Basic Information
| Provider Information | |||||||||
| NPI: | 1144398967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUFFSTUTTER | ||||||||
| FirstName: | M ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 STILLWATER DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724049119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 8709323611 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 STILLWATER DR | ||||||||
| Address2: | |||||||||
| City: | JONESBORO | ||||||||
| State: | AR | ||||||||
| PostalCode: | 724049119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8709323600 | ||||||||
| FaxNumber: | 8709323611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 09/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 2006035359 | MO | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TC0700X | 08-18P | AR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 181073719 | 05 | AR | MEDICAID |