Provider Demographics
NPI:1265227169
Name:HOULISTON, MARY (LPES)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOULISTON
Suffix:
Gender:
Credentials:LPES
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:408 SPRING LAKE LOOP
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7232
Mailing Address - Country:US
Mailing Address - Phone:407-579-3967
Mailing Address - Fax:
Practice Address - Street 1:800 E WASHINGTON ST STE K
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3054
Practice Address - Country:US
Practice Address - Phone:864-569-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool