Healthcare Provider Details

I. General information

NPI: 1346337656
Provider Name (Legal Business Name): MICHAEL ANTON HOUSTON LCSW , LMSW, RAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 02/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 G ST
SACRAMENTO CA
95816-3784
US

IV. Provider business mailing address

5050 LAGUNA BLVD STE 112-107
ELK GROVE CA
95758-4151
US

V. Phone/Fax

Practice location:
  • Phone: 916-500-4828
  • Fax:
Mailing address:
  • Phone: 916-271-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberH0504101828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6801083726
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 28197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: