Provider Demographics
NPI:1437876950
Name:HOUSTON, COURTNEY (FPSS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:FPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11976 CADILLAC DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051-8614
Mailing Address - Country:US
Mailing Address - Phone:502-381-2738
Mailing Address - Fax:
Practice Address - Street 1:11976 CADILLAC DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-8614
Practice Address - Country:US
Practice Address - Phone:502-381-2738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health