Healthcare Provider Details

I. General information

NPI: 1699944637
Provider Name (Legal Business Name): MICHELLE YVONNE HOUSTON LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 10/15/2023
Certification Date: 10/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

IV. Provider business mailing address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7151
  • Fax: 785-240-7438
Mailing address:
  • Phone: 785-239-7151
  • Fax: 785-240-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4167
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4167
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: