Provider Demographics
NPI: | 1619276680 |
---|---|
Name: | HOUSTON, KAREN RENEE |
Entity Type: | Individual |
Prefix: | |
First Name: | KAREN |
Middle Name: | RENEE |
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: | 6584 HIGHBURY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | DAYTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45424-3017 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-559-9558 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 813 TROY ST |
Practice Address - Street 2: | |
Practice Address - City: | DAYTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45404-1852 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-982-5100 |
Practice Address - Fax: | 937-982-1600 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2011-03-16 |
Last Update Date: | 2024-02-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | RN.339604 | 163W00000X, 163WA0400X, 163WP0807X, 163WP0808X, 163WC0400X, 163WH0200X, 320600000X, 322D00000X, 385HR2055X, 385HR2060X |
OH | 342000000X, 171M00000X, 172A00000X, 347E00000X | |
OH | S.0701532 | 104100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) |
No | 163WP0807X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Child & Adolescent |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health |
No | 163WC0400X | Nursing Service Providers | Registered Nurse | Case Management |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 342000000X | Transportation Services | Transportation Network Company | |
No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | |
No | 172A00000X | Other Service Providers | Driver | |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 347E00000X | Transportation Services | Transportation Broker | |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 3141031 | Medicaid |