Basic Information
| Provider Information | |||||||||
| NPI: | 1477115186 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSTON | ||||||||
| FirstName: | DARRELL | ||||||||
| MiddleName: | CHARLES KAWIKA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5209 N 42ND ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083451754 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5209 N 42ND ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083451754 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2019 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 07/08/2021 | ||||||||
| NPIReactivationDate: | 07/22/2021 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MC60968378 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.