Provider Demographics
NPI:1356582928
Name:HOUSTON, VIVIAN MARIE (MS)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:MARIE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4243A N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6829
Mailing Address - Country:US
Mailing Address - Phone:414-357-7774
Mailing Address - Fax:
Practice Address - Street 1:6815 W CAPITOL DR STE 208
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2056
Practice Address - Country:US
Practice Address - Phone:414-466-3204
Practice Address - Fax:414-466-3206
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI144417304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12553874OtherCOUNSELING, MARRIAGE & FAMILY THERAPY, GROUP THERAPY, AODA