Provider Demographics
NPI:1093288375
Name:HOUCK, JAMIE (BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HOUCK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TUCKERTON RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8652
Mailing Address - Country:US
Mailing Address - Phone:609-220-8917
Mailing Address - Fax:
Practice Address - Street 1:1256 MARLKRESS RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2626
Practice Address - Country:US
Practice Address - Phone:856-888-1097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-18-33265103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst