Provider Demographics
NPI:1235678830
Name:HOUSTON-VOLDEN, LYNNETTE RESHAWN
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:RESHAWN
Last Name:HOUSTON-VOLDEN
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 1:2345 S ALMA SCHOOL RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-4013
Mailing Address - Country:US
Mailing Address - Phone:602-712-6320
Mailing Address - Fax:
Practice Address - Street 1:2345 S ALMA SCHOOL RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4013
Practice Address - Country:US
Practice Address - Phone:602-919-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-13275101YA0400X
AZLMFT-15550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1659159325OtherNPI TYPE 2