Provider Demographics
NPI:1891471504
Name:HOUSTON, GEORDYN DANIELLE (LMSW)
Entity Type:Individual
Prefix:
First Name:GEORDYN
Middle Name:DANIELLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 FLEETRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:TN
Mailing Address - Zip Code:37690-2745
Mailing Address - Country:US
Mailing Address - Phone:423-948-0853
Mailing Address - Fax:
Practice Address - Street 1:155 FLEETRIDGE LN
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:TN
Practice Address - Zip Code:37690-2745
Practice Address - Country:US
Practice Address - Phone:423-948-0853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN142331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical