Provider Demographics
NPI:1417546789
Name:HOUGH, MICA CHRISTINE
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:CHRISTINE
Last Name:HOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICA
Other - Middle Name:C
Other - Last Name:MOELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7251 W NORTH AVE # 6
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1851
Mailing Address - Country:US
Mailing Address - Phone:608-535-9453
Mailing Address - Fax:
Practice Address - Street 1:7251 W NORTH AVE # 6
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1851
Practice Address - Country:US
Practice Address - Phone:608-535-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional