Healthcare Provider Details

I. General information

NPI: 1588799936
Provider Name (Legal Business Name): WES S HOUSTON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 MONTGOMERY RD SUITE 210
CINCINNATI OH
45212-2198
US

IV. Provider business mailing address

4805 MONTGOMERY RD SUITE 150
CINCINNATI OH
45212-2198
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-2370
  • Fax: 513-241-6053
Mailing address:
  • Phone: 513-241-2370
  • Fax: 513-241-6053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: