Provider Demographics
NPI:1962429514
Name:HUSTON, CANDRA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:CANDRA
Middle Name:A
Last Name:HUSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-9727
Mailing Address - Country:US
Mailing Address - Phone:512-680-5511
Mailing Address - Fax:512-281-4212
Practice Address - Street 1:2271 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-5727
Practice Address - Country:US
Practice Address - Phone:512-680-5511
Practice Address - Fax:512-281-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1026916-01Medicaid
TX1026916-01Medicaid