Healthcare Provider Details

I. General information

NPI: 1891930558
Provider Name (Legal Business Name): FELICIA HOUSTON M.A., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E 79TH ST
CHICAGO IL
60619-2302
US

IV. Provider business mailing address

8241 S ESSEX AVE
CHICAGO IL
60617-1923
US

V. Phone/Fax

Practice location:
  • Phone: 773-487-0515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: