Provider Demographics
NPI:1356709729
Name:HUSTON, MELISSA A (LCSW)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:HUSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PEBBLE CREEK DR S
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-8808
Mailing Address - Country:US
Mailing Address - Phone:903-806-3547
Mailing Address - Fax:
Practice Address - Street 1:1800 JUDSON RD STE 2000
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4743
Practice Address - Country:US
Practice Address - Phone:903-806-3547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56826101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)