Provider Demographics
NPI:1407075609
Name:HOUSE, JOHN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HOUSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 FOX RD
Mailing Address - Street 2:STE E
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3349
Mailing Address - Country:US
Mailing Address - Phone:865-567-5648
Mailing Address - Fax:865-531-3948
Practice Address - Street 1:135 FOX RD
Practice Address - Street 2:STE E
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3349
Practice Address - Country:US
Practice Address - Phone:865-567-5648
Practice Address - Fax:865-531-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1522103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN137244OtherBLUE CROSS ID NUMBER
TN3981643Medicare ID - Type UnspecifiedPROVIDER ID
TN137244OtherBLUE CROSS ID NUMBER