Provider Demographics
NPI:1689305831
Name:HOUSTON, OCIE (LCDCI)
Entity Type:Individual
Prefix:
First Name:OCIE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LCDCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11931 GREENSBROOK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-7282
Mailing Address - Country:US
Mailing Address - Phone:346-392-1934
Mailing Address - Fax:
Practice Address - Street 1:4525 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-7901
Practice Address - Country:US
Practice Address - Phone:346-392-1934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59374101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164745550Medicaid