Provider Demographics
NPI:1013007145
Name:HOUSER, AMY LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:HOUSER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26559 BARRANQUILLA AVE
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-5728
Mailing Address - Country:US
Mailing Address - Phone:941-893-7917
Mailing Address - Fax:
Practice Address - Street 1:26559 BARRAQUILLA AVENUE
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983
Practice Address - Country:US
Practice Address - Phone:941-893-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW141471041C0700X
FLMT2784106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist