Provider Demographics
NPI:1437721107
Name:HOUCK, THERESA MARIE (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:MARIE
Last Name:HOUCK
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 EAST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830
Mailing Address - Country:US
Mailing Address - Phone:607-936-1771
Mailing Address - Fax:607-936-2648
Practice Address - Street 1:111 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-2462
Practice Address - Country:US
Practice Address - Phone:607-936-1771
Practice Address - Fax:607-936-2648
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY096676-011041C0700X
NY0966761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical