Provider Demographics
NPI:1073902656
Name:HOUCK, RACHEL (LASAC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:LASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 E MISSOURI AVE
Mailing Address - Street 2:SUITE C-100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2362
Mailing Address - Country:US
Mailing Address - Phone:800-273-3429
Mailing Address - Fax:
Practice Address - Street 1:1300 E MISSOURI AVE
Practice Address - Street 2:SUITE C-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2362
Practice Address - Country:US
Practice Address - Phone:800-273-3429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13326101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)