Provider Demographics
NPI:1437286630
Name:HOUCK, LESLIE A (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:HOUCK
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KAY CIR
Mailing Address - Street 2:
Mailing Address - City:CHADWICKS
Mailing Address - State:NY
Mailing Address - Zip Code:13319-3300
Mailing Address - Country:US
Mailing Address - Phone:315-796-7224
Mailing Address - Fax:315-765-0351
Practice Address - Street 1:610 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1014
Practice Address - Country:US
Practice Address - Phone:315-765-0121
Practice Address - Fax:315-765-0351
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005007-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health