Healthcare Provider Details

I. General information

NPI: 1437626280
Provider Name (Legal Business Name): ANDREA HOUSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date: 09/28/2022
Reactivation Date: 08/14/2023

III. Provider practice location address

720 HOWE AVE
SACRAMENTO CA
95825-4669
US

IV. Provider business mailing address

7949 CALIFORNIA AVE STE 15
FAIR OAKS CA
95628-7156
US

V. Phone/Fax

Practice location:
  • Phone: 916-376-7736
  • Fax:
Mailing address:
  • Phone: 916-863-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PSEOHB
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: