Provider Demographics
NPI:1407066731
Name:HOUSTON, MICHELLE (BS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 JAMES HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39443-7412
Mailing Address - Country:US
Mailing Address - Phone:601-319-7768
Mailing Address - Fax:
Practice Address - Street 1:2020 HARDY ST
Practice Address - Street 2:SUITE 2-A
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-4941
Practice Address - Country:US
Practice Address - Phone:601-544-8556
Practice Address - Fax:601-544-8867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor