Provider Demographics
NPI:1285791558
Name:HOUSE, JOSEPH JOHNSTON (LP)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHNSTON
Last Name:HOUSE
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 WHITE BEAR AVE N
Mailing Address - Street 2:STE 403
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1307
Mailing Address - Country:US
Mailing Address - Phone:651-779-0069
Mailing Address - Fax:651-779-0206
Practice Address - Street 1:2785 WHITE BEAR AVE N
Practice Address - Street 2:STE 403
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1307
Practice Address - Country:US
Practice Address - Phone:651-779-0069
Practice Address - Fax:651-779-0206
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN705847100Medicaid
MN680000052Medicare ID - Type Unspecified