Provider Demographics
NPI:1417097692
Name:HOUSTON, REBECCA LEE (LCPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S STRAUGHAN AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-7849
Mailing Address - Country:US
Mailing Address - Phone:208-332-4445
Mailing Address - Fax:208-332-4447
Practice Address - Street 1:750 WARM SPRINGS AVE STE F
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6457
Practice Address - Country:US
Practice Address - Phone:208-332-4445
Practice Address - Fax:208-332-4447
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC 379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010154150OtherREGENCE BLUE SHIELD OF ID
IDQ7337OtherBLUE CROSS OF IDAHO