Provider Demographics
NPI:1760452346
Name:HOUDEK, THOMAS DALE (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DALE
Last Name:HOUDEK
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 1:117 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3235
Mailing Address - Country:US
Mailing Address - Phone:318-359-5858
Mailing Address - Fax:
Practice Address - Street 1:406 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2356
Practice Address - Country:US
Practice Address - Phone:318-253-1773
Practice Address - Fax:318-253-1773
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4437101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA203519878OtherEMPLOYER IDENTIFICATION N