Provider Demographics
NPI:1275713836
Name:HOUSLEY, KATHLEEN LUCILLE (LPC, LADAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LUCILLE
Last Name:HOUSLEY
Suffix:
Gender:F
Credentials:LPC, LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8488
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0009
Mailing Address - Country:US
Mailing Address - Phone:479-444-9363
Mailing Address - Fax:479-443-2049
Practice Address - Street 1:1130 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5150
Practice Address - Country:US
Practice Address - Phone:479-444-9363
Practice Address - Fax:479-443-2049
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2007-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0265L101YA0400X
ARP9306008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)