Provider Demographics
NPI:1255724696
Name:HOUSTON, PHD, NEAL (PHD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:HOUSTON, PHD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 ROUTE 611
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BARTONSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18321-7823
Mailing Address - Country:US
Mailing Address - Phone:570-872-9911
Mailing Address - Fax:570-688-4031
Practice Address - Street 1:391 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-9101
Practice Address - Country:US
Practice Address - Phone:570-872-9800
Practice Address - Fax:570-688-4031
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA103361103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA12610312OtherCAQH