Provider Demographics
NPI:1134641699
Name:HOUSTON, MARK COLIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:COLIN
Last Name:HOUSTON
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 1:1735 NE 137TH TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-1311
Mailing Address - Country:US
Mailing Address - Phone:305-859-1272
Mailing Address - Fax:
Practice Address - Street 1:1735 NE 137TH TER
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-1311
Practice Address - Country:US
Practice Address - Phone:305-859-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-16
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW168081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty