Provider Demographics
NPI:1659933133
Name:HOUSTON-CROOK, SAMANTHA PAIGE
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:PAIGE
Last Name:HOUSTON-CROOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 W MAIN ST UNIT 703
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-1528
Mailing Address - Country:US
Mailing Address - Phone:909-264-8566
Mailing Address - Fax:
Practice Address - Street 1:2558 GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8445
Practice Address - Country:US
Practice Address - Phone:209-541-5154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130698101YM0800X
CA118255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health