Isaac Donnell Huddleston, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

2008004281 Issued in MO

Practice address

392 Chez Paree Dr
Hazelwood, MO 63042-3539

Phone

(314) 833-7080

NPI assigned

Mar 9, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1972773646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 CHEZ PAREE DR",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630423539",
            "telephone_number": "314-833-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 CHEZ PAREE DR",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630423539",
            "telephone_number": "314-833-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDDLESTON",
        "first_name": "ISAAC",
        "middle_name": "DONNELL",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-09",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MO",
            "license": "2008004281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "494055700",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "http://mtcm314.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "392 Chez Paree Dr",
            "city": "Hazelwood",
            "state": "MO",
            "country_code": "US",
            "postal_code": "630423539",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Counselor in Hazelwood, MO
• Providers in Hazelwood, MO by specialty
• Counselor in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.