MEDICARE: STEVEN DANIEL HOUSTON MS, BCBA

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	222Q00000X	Developmental Therapist
2	103K00000X	Behavior Analyst	1-12-11857	GA

General Provider Information

NPI Number	:	1629412028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN DANIEL HOUSTON MS, BCBA

Provider Business Mailing Address
First Line	:	1735 SPOUT SPRINGS RD SW
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-2313
Country	:	US
Telephone Number	:	706-506-5777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 SPOUT SPRINGS RD SW
Second Line	:
City	:	CAVE SPRING
State	:	GA
Zip	:	30124-2313
Country	:	US
Telephone Number	:	706-506-5777
Fax Number	:

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

Provider Enumeration Date	:	04/29/2013
Last Update Date	:	08/21/2019

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