Provider Demographics
NPI:1750510863
Name:HOULIHAN, LYNN SUE (CSAC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:SUE
Last Name:HOULIHAN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440B CHURCH ST
Mailing Address - Street 2:PO BOX 348
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5315
Mailing Address - Country:US
Mailing Address - Phone:715-295-9618
Mailing Address - Fax:715-295-9621
Practice Address - Street 1:3440B CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5315
Practice Address - Country:US
Practice Address - Phone:715-295-9618
Practice Address - Fax:715-295-9621
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13862-131101YA0400X
WI7792-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)