Provider Demographics
NPI:1467962514
Name:HUSTON, STEPHANIE KAY (NMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:KAY
Last Name:HUSTON
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KAY
Other - Last Name:HUSTON MYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:44725 N. 14TH ST.
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087
Mailing Address - Country:US
Mailing Address - Phone:602-920-9614
Mailing Address - Fax:
Practice Address - Street 1:44725 N 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6530
Practice Address - Country:US
Practice Address - Phone:602-920-9614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1637175L00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath