Provider Demographics
NPI:1437601150
Name:HOUSTON, MARIA NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:NICOLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 PALMER PARK CIR E APT 104
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1176
Mailing Address - Country:US
Mailing Address - Phone:614-598-5096
Mailing Address - Fax:
Practice Address - Street 1:4140 PALMER PARK CIR E APT 104
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-1176
Practice Address - Country:US
Practice Address - Phone:614-598-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSE065043OtherDRIVER'S LICENSE