MEDICARE: ERIC HOUSTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1043833445
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC HOUSTON

Provider Business Mailing Address
First Line	:	3906 HATHAWAY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-5125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3906 HATHAWAY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90815-5125
Country	:	US
Telephone Number	:	347-200-7227
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERIC HOUSTON
Credential	:
Telephone Number	:	347-200-7227

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/20/2020

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Directions to “ERIC HOUSTON ” Practice Location

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