Basic Information
Provider Information
NPI: 1518056076
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUXLEY
FirstName: RONALD
MiddleName: EUGENE
NamePrefix: MR.
NameSuffix: JR.
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 71 N. MAIN
Address2:  
City: TEMPLETON
State: CA
PostalCode: 93465
CountryCode: US
TelephoneNumber: 8054342449
FaxNumber: 8054343839
Practice Location
Address1: 71 N. MAIN
Address2:  
City: TEMPLETON
State: CA
PostalCode: 93465
CountryCode: US
TelephoneNumber: 8054342449
FaxNumber: 8054343839
Other Information
ProviderEnumerationDate: 10/12/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC35134CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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