Individual
CARLISS G HOUSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
106 HICKORY ST, THIBODAUX, LA 70301-2008
(985) 446-4114
(985) 446-4112
Mailing address
PO BOX 29, THIBODAUX, LA 70302-0029
(985) 446-4114
(985) 446-4112
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/18/2019
Last updated
02/18/2019
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