Basic Information
Provider Information
NPI: 1720425358
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUGGETT
FirstName: CHRISTINA
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: M.A., BCBA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3340 SUDBURY RD
Address2:  
City: CAMERON PARK
State: CA
PostalCode: 956828275
CountryCode: US
TelephoneNumber: 9165493279
FaxNumber:  
Practice Location
Address1: 425 UNIVERSITY AVE
Address2: SUITE 201
City: SACRAMENTO
State: CA
PostalCode: 958256520
CountryCode: US
TelephoneNumber: 9164482050
FaxNumber: 9164486050
Other Information
ProviderEnumerationDate: 05/22/2013
LastUpdateDate: 05/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X1-12-11759CAY Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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