Provider Demographics
NPI:1033205752
Name:HOUCK, BRADLEY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:HOUCK
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 HIGH ST SE STE 254
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3610
Mailing Address - Country:US
Mailing Address - Phone:503-400-6364
Mailing Address - Fax:
Practice Address - Street 1:161 HIGH ST SE STE 254
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3610
Practice Address - Country:US
Practice Address - Phone:503-400-6364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL42221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR146946Medicare PIN
R146946Medicare PIN