Provider Demographics
NPI:1730284530
Name:HOUK, BRANDON M (LMHC)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:M
Last Name:HOUK
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N PONCE DE LEON BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2650
Mailing Address - Country:US
Mailing Address - Phone:208-716-0425
Mailing Address - Fax:
Practice Address - Street 1:2200 N PONCE DE LEON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2650
Practice Address - Country:US
Practice Address - Phone:208-716-0425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC3487101YM0800X
FLMH12288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002658300Medicaid
ID820428306OtherIDAHO PHYSICIANS NETWORK
ID820428306OtherTRICARE
IDX6882OtherBLUE CROSS OF IDAHO
ID000010151980OtherBLUE SHIELD