Healthcare Provider Details

I. General information

NPI: 1962429514
Provider Name (Legal Business Name): CANDRA A. HUSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2271 W HIGHWAY 290
GIDDINGS TX
78942-5727
US

IV. Provider business mailing address

101 PINE CONE LN
ELGIN TX
78621-9727
US

V. Phone/Fax

Practice location:
  • Phone: 512-680-5511
  • Fax: 512-281-4212
Mailing address:
  • Phone: 512-680-5511
  • Fax: 512-281-4212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: