Provider Demographics
NPI:1356810055
Name:HOUSTON, SHAUNDRED DEJUAN (MHP)
Entity type:Individual
Prefix:MR
First Name:SHAUNDRED
Middle Name:DEJUAN
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:COTTON VALLEY
Mailing Address - State:LA
Mailing Address - Zip Code:71018-0602
Mailing Address - Country:US
Mailing Address - Phone:318-773-1788
Mailing Address - Fax:
Practice Address - Street 1:2715 MACKEY PL STE 135
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2528
Practice Address - Country:US
Practice Address - Phone:318-220-8423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health