Provider Demographics
NPI:1003706656
Name:HOUSTON, ANDRE LAMONT
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:LAMONT
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W BREESE RD
Mailing Address - Street 2:
Mailing Address - City:FORT SHAWNEE
Mailing Address - State:OH
Mailing Address - Zip Code:45806-1706
Mailing Address - Country:US
Mailing Address - Phone:567-204-2544
Mailing Address - Fax:
Practice Address - Street 1:1840 W BREESE RD
Practice Address - Street 2:
Practice Address - City:FORT SHAWNEE
Practice Address - State:OH
Practice Address - Zip Code:45806-1706
Practice Address - Country:US
Practice Address - Phone:567-204-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide