Provider Demographics
NPI:1053392415
Name:HUFF, DONNELL R (LCSW)
Entity type:Individual
Prefix:MS
First Name:DONNELL
Middle Name:R
Last Name:HUFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DONNELL
Other - Middle Name:
Other - Last Name:GATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 WELLER ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1942
Mailing Address - Country:US
Mailing Address - Phone:660-395-0180
Mailing Address - Fax:660-395-0181
Practice Address - Street 1:303 WELLER ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1942
Practice Address - Country:US
Practice Address - Phone:660-395-0180
Practice Address - Fax:660-395-0181
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020211291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495048001Medicaid
MO000078586Medicare ID - Type Unspecified