Provider Demographics
NPI:1124843925
Name:HOUSTON, JAAVON
Entity type:Individual
Prefix:
First Name:JAAVON
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6720 CEDAR AVE S APT 3
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2753
Mailing Address - Country:US
Mailing Address - Phone:763-245-9438
Mailing Address - Fax:
Practice Address - Street 1:4201 DEAN LAKES BLVD STE 160
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2863
Practice Address - Country:US
Practice Address - Phone:612-509-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician