Provider Demographics
NPI:1073664413
Name:HUSTON, KATHLEEN ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANNE
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 FAULKNER DR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5672
Mailing Address - Country:US
Mailing Address - Phone:979-764-2879
Mailing Address - Fax:979-693-5556
Practice Address - Street 1:2508 FAULKNER DR
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5672
Practice Address - Country:US
Practice Address - Phone:979-764-2879
Practice Address - Fax:979-693-5556
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23350103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U88FMedicare PIN