Provider Demographics
NPI:1538551049
Name:HOUGHTON, BRIAN JR (LADC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:HOUGHTON
Suffix:JR
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RALSTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3668
Mailing Address - Country:US
Mailing Address - Phone:603-499-3001
Mailing Address - Fax:603-719-2143
Practice Address - Street 1:51 RALSTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3668
Practice Address - Country:US
Practice Address - Phone:603-499-3001
Practice Address - Fax:603-719-2143
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-21
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
11821740OtherCAQH
NH3102452Medicaid