MEDICARE: DIANE MARIE HOUSTON LPC, NCC

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	101YM0800X	Mental Health Counselor	LPC.0015766	CO

General Provider Information

NPI Number	:	1477194504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE MARIE HOUSTON LPC, NCC

Provider Business Mailing Address
First Line	:	4233 WHITTIER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4233 WHITTIER DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-2541
Country	:	US
Telephone Number	:	719-244-6565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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