Basic Information
| Provider Information | |||||||||
| NPI: | 1588794382 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUSTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16221 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374160221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233132240 | ||||||||
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| Practice Location | |||||||||
| Address1: | 717 E 11TH ST | ||||||||
| Address2: | HOMELESS HEALTH CARE CENTER | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374033104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232655708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 05/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 2902 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.