Basic Information
| Provider Information | |||||||||
| NPI: | 1760988190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUVLER | ||||||||
| FirstName: | LANDON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 W GAMBIER ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430502421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403269099 | ||||||||
| FaxNumber: | 7403269099 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 W GAMBIER ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430502421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197473322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 11/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | CDCA.080783 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 0273604 | 05 | OH | MEDICAID |