Provider Demographics
NPI:1760080030
Name:HUSTON, STEPHANIE N (BS, BCABA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:HUSTON
Suffix:
Gender:F
Credentials:BS, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 EAGLE DR APT 26
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6747
Mailing Address - Country:US
Mailing Address - Phone:512-986-0078
Mailing Address - Fax:
Practice Address - Street 1:6399 FISHTRAP RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-1607
Practice Address - Country:US
Practice Address - Phone:214-608-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3636103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst