Healthcare Provider Details

I. General information

NPI: 1093077638
Provider Name (Legal Business Name): EDWIN HUSTON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SAWMILL RD SUITE 210
DUBLIN OH
43017-3538
US

IV. Provider business mailing address

5900 SAWMILL RD SUITE 210
DUBLIN OH
43017-3538
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-9652
  • Fax: 614-717-9657
Mailing address:
  • Phone: 614-717-9652
  • Fax: 614-717-9657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0700340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: