MEDICARE: DR. MITCHELL JOHN HOUSTON PHD

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	103T00000X	Psychologist	PSY 16056	CA

General Provider Information

NPI Number	:	1598811051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL JOHN HOUSTON PHD

Provider Business Mailing Address
First Line	:	925 THE ALAMEDA
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2310
Country	:	US
Telephone Number	:	925-254-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	925 THE ALAMEDA
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2310
Country	:	US
Telephone Number	:	925-254-1304
Fax Number	:

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	02/11/2022

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