Provider Demographics
NPI:1326000480
Name:HOUTTUIN, MONICA J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:J
Last Name:HOUTTUIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:104 S MCKINLEY STE D
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-0700
Mailing Address - Country:US
Mailing Address - Phone:636-583-7738
Mailing Address - Fax:636-583-6745
Practice Address - Street 1:104 S MCKINLEY AVE
Practice Address - Street 2:STE D
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084
Practice Address - Country:US
Practice Address - Phone:636-583-7738
Practice Address - Fax:636-583-6745
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW003059104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO8512OtherBCBS
MOR44704OtherMERCY
MOR44704OtherMERCY