Healthcare Provider Details

I. General information

NPI: 1134054323
Provider Name (Legal Business Name): DANIEL HUSTON CADAC II, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 E DUNES HWY
GARY IN
46304
US

IV. Provider business mailing address

5001 E DUNES HWY
GARY IN
46403-2894
US

V. Phone/Fax

Practice location:
  • Phone: 219-938-4651
  • Fax:
Mailing address:
  • Phone: 219-938-4651
  • Fax: 219-938-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number86000457A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: