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NPI Code Detail

MEDICARE: SAMANTHA ANN HUSTON LCPC

MEDICARE: SAMANTHA ANN HUSTON LCPC
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
1101YP2500XProfessional Counselor180.010706IL

General Provider Information

NPI Number : 1992210306
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA ANN HUSTON LCPC
Provider Business Mailing Address
First Line : 754 W BUENA AVE APT 1W
Second Line :
City : CHICAGO
State : IL
Zip : 60613-0080
Country : US
Telephone Number : 312-888-1523
Fax Number :
Provider Business Practice Location Address
First Line : 4621 N RAVENSWOOD AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4509
Country : US
Telephone Number : 312-888-1523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2017
Last Update Date : 04/29/2025

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