Provider Demographics
NPI:1043423031
Name:HOUGLAND, PENNY (LICSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:HOUGLAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 HARRIS AVE
Mailing Address - Street 2:STE 201H
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7080
Mailing Address - Country:US
Mailing Address - Phone:360-758-4234
Mailing Address - Fax:360-758-4234
Practice Address - Street 1:909 HARRIS AVE
Practice Address - Street 2:STE 201H
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-7080
Practice Address - Country:US
Practice Address - Phone:360-758-4234
Practice Address - Fax:360-758-4234
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV8850111061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001718108OtherMOUNTAIN STATE BLUE CROSS