Healthcare Provider Details

I. General information

NPI: 1720907181
Provider Name (Legal Business Name): CHARLOTTE M HOUSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR STE 329
NAMPA ID
83687-7912
US

IV. Provider business mailing address

777 N RAYMOND ST
BOISE ID
83704-9251
US

V. Phone/Fax

Practice location:
  • Phone: 208-514-2509
  • Fax: 208-375-2217
Mailing address:
  • Phone: 208-514-2500
  • Fax: 208-375-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9081008
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: