Provider Demographics
NPI:1710669833
Name:HOUGH, COREY (CHES)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HOUGH
Suffix:
Gender:M
Credentials:CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3862 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7859
Mailing Address - Country:US
Mailing Address - Phone:518-567-8192
Mailing Address - Fax:
Practice Address - Street 1:1396 HIGHWAY 544
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8443
Practice Address - Country:US
Practice Address - Phone:843-347-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
38176174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator