Provider Demographics
NPI:1154598639
Name:HOUSTON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4993 GOLDEN FOOTHILL PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-941-8812
Mailing Address - Fax:
Practice Address - Street 1:4993 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-941-8812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health