Provider Demographics
NPI:1316495294
Name:HOUSTON, KEISHA SELVAGE (PLPC)
Entity type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:SELVAGE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54341
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70892-4341
Mailing Address - Country:US
Mailing Address - Phone:225-806-0797
Mailing Address - Fax:225-960-2984
Practice Address - Street 1:1520 THOMAS H DELPIT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70802-6626
Practice Address - Country:US
Practice Address - Phone:225-636-2395
Practice Address - Fax:225-960-2984
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator