MEDICARE: MISS CARISA MARIE HOUSTON CSAC, CS-IT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	15446	IL
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	15528131	WI
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	15606-132	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376729996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARISA MARIE HOUSTON CSAC, CS-IT

Provider Business Mailing Address
First Line	:	3171 N 10TH ST # 21
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-3253
Country	:	US
Telephone Number	:	414-218-2735
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 CLARMAR DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2664
Country	:	US
Telephone Number	:	608-445-4886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	03/03/2026

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