Provider Demographics
NPI:1760259915
Name:HOUCK RESTORATION CENTER LLC
Entity Type:Organization
Organization Name:HOUCK RESTORATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-216-0098
Mailing Address - Street 1:PO BOX 1742
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512-1742
Mailing Address - Country:US
Mailing Address - Phone:928-216-0098
Mailing Address - Fax:
Practice Address - Street 1:295 COUNTY ROAD 1.5 MILE NW HOUCK CHAPTER HOUSE
Practice Address - Street 2:
Practice Address - City:HOUCK
Practice Address - State:AZ
Practice Address - Zip Code:86506
Practice Address - Country:US
Practice Address - Phone:928-216-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty