Provider Demographics
NPI:1538116140
Name:HOUSTON, KENNETH CHUCK (LCSW)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHUCK
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 MAIN ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-2999
Mailing Address - Country:US
Mailing Address - Phone:360-695-0115
Mailing Address - Fax:360-695-3436
Practice Address - Street 1:1104 MAIN ST
Practice Address - Street 2:SUITE 500
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-2999
Practice Address - Country:US
Practice Address - Phone:360-695-0115
Practice Address - Fax:360-695-3436
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0207041041C0700X
OR3509851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000615509Medicare ID - Type Unspecified