Provider Demographics
NPI:1710280706
Name:HOUSTON, PETER (MSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5431 E MAYFLOWER LN STE 5
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7891
Mailing Address - Country:US
Mailing Address - Phone:907-357-6860
Mailing Address - Fax:907-357-6865
Practice Address - Street 1:5431 E MAYFLOWER LN STE 5
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7891
Practice Address - Country:US
Practice Address - Phone:907-357-6860
Practice Address - Fax:907-357-6865
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)