Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1184054447 |
---|---|
Provider Name | Mr. Marlon Houston |
First Address | Pawnee, OK 74058-3517 |
Second Address | Pawnee, OK 74058-3517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 22/11/2013 |