Provider Demographics
NPI:1265908511
Name:HOUSTON, RAYMOND JR (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:HOUSTON
Suffix:JR
Gender:M
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 FAIRLAWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-9999
Mailing Address - Country:US
Mailing Address - Phone:417-388-9872
Mailing Address - Fax:
Practice Address - Street 1:2411 FAIRLAWN DRIVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-9999
Practice Address - Country:US
Practice Address - Phone:417-388-9872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty