Provider Demographics
NPI:1407404890
Name:HOUSTON, TERESA LEANNE (LMAC)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LEANNE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 N MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3618
Mailing Address - Country:US
Mailing Address - Phone:316-440-1600
Mailing Address - Fax:
Practice Address - Street 1:610 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3618
Practice Address - Country:US
Practice Address - Phone:316-440-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS432101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)