Provider Demographics
NPI:1043947088
Name:HOUSTON, TAMYA NICOLE
Entity Type:Individual
Prefix:
First Name:TAMYA
Middle Name:NICOLE
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 1:475 PROVIDENCE MAIN ST NW STE 201
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4828
Mailing Address - Country:US
Mailing Address - Phone:256-489-8660
Mailing Address - Fax:
Practice Address - Street 1:475 PROVIDENCE MAIN ST NW STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4828
Practice Address - Country:US
Practice Address - Phone:256-489-8660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician