Provider Demographics
NPI:1225022940
Name:HEUSTON, PEGGY J (LPC-MH, QMHP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:J
Last Name:HEUSTON
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14141 WHITECAP BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-6221
Mailing Address - Country:US
Mailing Address - Phone:361-949-3212
Mailing Address - Fax:361-949-3212
Practice Address - Street 1:14141 WHITECAP BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78418-6221
Practice Address - Country:US
Practice Address - Phone:361-949-3212
Practice Address - Fax:361-949-3212
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2088101YM0800X
TX66193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health