Provider Demographics
NPI:1477544039
Name:HOUSE, PHILIP ALVIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALVIN
Last Name:HOUSE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22098
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-2098
Mailing Address - Country:US
Mailing Address - Phone:406-245-4446
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:1629 AVENUE D
Practice Address - Street 2:BLDG B, SUITE 2
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3042
Practice Address - Country:US
Practice Address - Phone:406-245-4446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT270103TC0700X
MT45407103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT490321Medicaid
MT490321Medicaid