Provider Demographics
NPI:1245761170
Name:VANHOUTTE, CRAIG PATRICK (MSC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:PATRICK
Last Name:VANHOUTTE
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3151 QUEEN CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5400
Mailing Address - Country:US
Mailing Address - Phone:720-323-2271
Mailing Address - Fax:
Practice Address - Street 1:5400 W JEWELL AVE STE 1C
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80232-7206
Practice Address - Country:US
Practice Address - Phone:303-988-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC0107309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CONLC0107309OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES