Provider Demographics
NPI:1861832016
Name:HOUSDEN, ROBERT LEE (RAS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:HOUSDEN
Suffix:
Gender:M
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 MCHENRY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-1451
Mailing Address - Country:US
Mailing Address - Phone:209-523-6910
Mailing Address - Fax:209-523-6912
Practice Address - Street 1:3125 MCHENRY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1451
Practice Address - Country:US
Practice Address - Phone:209-523-6910
Practice Address - Fax:209-523-6912
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500010BN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)