1326000480 NPI number — MS. MONICA J HOUTTUIN LCSW

Table of content: MS. MONICA J HOUTTUIN LCSW (NPI 1326000480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326000480 NPI number — MS. MONICA J HOUTTUIN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUTTUIN
Provider First Name:
MONICA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326000480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700
Provider Second Line Business Mailing Address:
104 S MCKINLEY STE D
Provider Business Mailing Address City Name:
UNION
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63084-0700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-583-7738
Provider Business Mailing Address Fax Number:
636-583-6745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 S MCKINLEY AVE
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-583-7738
Provider Business Practice Location Address Fax Number:
636-583-6745
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  SW003059 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8512 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: R44704 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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