Provider Demographics
NPI:1033752340
Name:HOUTAN, HOUTANEH (NMD)
Entity Type:Individual
Prefix:DR
First Name:HOUTANEH
Middle Name:
Last Name:HOUTAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402B MULBERRY CV
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2732
Mailing Address - Country:US
Mailing Address - Phone:609-513-7913
Mailing Address - Fax:
Practice Address - Street 1:5 W CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MERCHANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08109-2309
Practice Address - Country:US
Practice Address - Phone:856-316-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19-1814175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath