Provider Demographics
NPI:1083355390
Name:HUSTON, ROBERT (AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HUSTON
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 MOORE BLVD APT 131
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-7680
Mailing Address - Country:US
Mailing Address - Phone:707-372-1963
Mailing Address - Fax:
Practice Address - Street 1:200 BAKER ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1910
Practice Address - Country:US
Practice Address - Phone:530-794-6000
Practice Address - Fax:530-794-6076
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11165101YM0800X
CA131179106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health