Provider Demographics
NPI:1649336272
Name:HOUSTON, DAVID R (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 STONE STREET
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5222
Mailing Address - Country:US
Mailing Address - Phone:207-622-3800
Mailing Address - Fax:
Practice Address - Street 1:23 STONE STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5222
Practice Address - Country:US
Practice Address - Phone:207-622-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM2539Medicare ID - Type Unspecified