Provider Demographics
NPI:1427572379
Name:HOUSTON, CHASITY LEA
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:LEA
Last Name:HOUSTON
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 1:608 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-4810
Mailing Address - Country:US
Mailing Address - Phone:918-448-6448
Mailing Address - Fax:
Practice Address - Street 1:1600 N D ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-2314
Practice Address - Country:US
Practice Address - Phone:918-423-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator