Healthcare Provider Details

I. General information

NPI: 1912043837
Provider Name (Legal Business Name): HOLLY L HUSTON PHD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 SUNSET BLVD.
HOUSTON TX
77005
US

IV. Provider business mailing address

2430 SUNSET BLVD.
HOUSTON TX
77005
US

V. Phone/Fax

Practice location:
  • Phone: 713-523-3322
  • Fax: 713-520-6001
Mailing address:
  • Phone: 713-523-3322
  • Fax: 713-520-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number15394
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15394
License Number StateTX

VIII. Authorized Official

Name: HOLLY L HUSTON
Title or Position: OWNER
Credential: PHD
Phone: 713-623-6263