Provider Demographics
NPI:1992947519
Name:HUSTON, THERESA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:HUSTON
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:FLEBOTTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:7530 103RD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6786
Mailing Address - Country:US
Mailing Address - Phone:904-872-2225
Mailing Address - Fax:406-559-3241
Practice Address - Street 1:7530 103RD ST STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6786
Practice Address - Country:US
Practice Address - Phone:904-872-2225
Practice Address - Fax:406-559-3241
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT865LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical