Provider Demographics
NPI:1649711136
Name:HOUSTON, LEILANI
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 W BOWLES AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3455
Mailing Address - Country:US
Mailing Address - Phone:303-736-9117
Mailing Address - Fax:
Practice Address - Street 1:8906 W BOWLES AVE STE 110
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3455
Practice Address - Country:US
Practice Address - Phone:303-736-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00002114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist