Provider Demographics
NPI:1376640250
Name:HUSTON, JUDITH D (MA, MDIV)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:D
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SNOW CT
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3914
Mailing Address - Country:US
Mailing Address - Phone:925-528-9414
Mailing Address - Fax:925-377-0584
Practice Address - Street 1:23 ALTARINDA RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2600
Practice Address - Country:US
Practice Address - Phone:925-528-9414
Practice Address - Fax:925-377-0584
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist