Provider Demographics
NPI:1902309487
Name:HUSETH, TINA RENAE (LCDC, LPC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENAE
Last Name:HUSETH
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11849 COUNTY ROAD 461
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75706-4823
Mailing Address - Country:US
Mailing Address - Phone:903-920-7847
Mailing Address - Fax:903-686-0394
Practice Address - Street 1:11849 COUNTY ROAD 461
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75706-4823
Practice Address - Country:US
Practice Address - Phone:903-920-7847
Practice Address - Fax:903-686-0394
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82779101YP2500X, 101YM0800X, 101Y00000X
TX13554101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty