Provider Demographics
NPI:1043565914
Name:HOUSTON, AMY R
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 ALLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7601
Mailing Address - Country:US
Mailing Address - Phone:405-816-9468
Mailing Address - Fax:
Practice Address - Street 1:10948 N MAY AVE
Practice Address - Street 2:B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6223
Practice Address - Country:US
Practice Address - Phone:405-751-8889
Practice Address - Fax:405-751-8966
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200287120AMedicaid