Provider Demographics
NPI:1295228013
Name:HOUGHTALING, TERRI BETH
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:BETH
Last Name:HOUGHTALING
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 1:3205 OLD UNION RD APT 315
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4265
Mailing Address - Country:US
Mailing Address - Phone:936-219-9707
Mailing Address - Fax:
Practice Address - Street 1:3205 OLD UNION RD APT 315
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-4265
Practice Address - Country:US
Practice Address - Phone:936-219-9707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72753164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse