Provider Demographics
NPI:1972512622
Name:HOUDESHELL, SETH GRADON (LCSW)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:GRADON
Last Name:HOUDESHELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 1/2 S CONGRESS AVE
Mailing Address - Street 2:SUITE P
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-3559
Mailing Address - Country:US
Mailing Address - Phone:512-466-0835
Mailing Address - Fax:
Practice Address - Street 1:1704 1/2 S CONGRESS AVE
Practice Address - Street 2:SUITE P
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3559
Practice Address - Country:US
Practice Address - Phone:512-466-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0073LJOtherBLUE CROSS BLUE SHIELD
TX2207482OtherCIGNA BEHAVIORAL
TX611142Medicare ID - Type Unspecified