Provider Demographics
NPI:1093451874
Name:HOUCHINS, MALLORY (PLPC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:HOUCHINS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NORTH BUSINESS 61
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334
Mailing Address - Country:US
Mailing Address - Phone:573-954-7375
Mailing Address - Fax:
Practice Address - Street 1:305 N. BUSINESS 61
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63441
Practice Address - Country:US
Practice Address - Phone:573-954-7375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1093323990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health