Provider Demographics
NPI:1922519206
Name:HUSTON, STACI (PCP, LIMHP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:PCP, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2131
Mailing Address - Country:US
Mailing Address - Phone:402-562-8955
Mailing Address - Fax:402-564-0611
Practice Address - Street 1:2740 N CLARKSON ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-7702
Practice Address - Country:US
Practice Address - Phone:402-721-0951
Practice Address - Fax:402-564-0611
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health