Provider Demographics
NPI:1679619597
Name:HUSTON, HOLLY (PHD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WESLAYAN
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5753
Mailing Address - Country:US
Mailing Address - Phone:713-623-6263
Mailing Address - Fax:713-623-4243
Practice Address - Street 1:3000 WESLAYAN
Practice Address - Street 2:SUITE 305
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5753
Practice Address - Country:US
Practice Address - Phone:713-623-6263
Practice Address - Fax:713-623-4243
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15394103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical