Provider Demographics
NPI:1922136043
Name:HOUCK STROM, SUSAN (LMFT, ATR)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:HOUCK STROM
Suffix:
Gender:F
Credentials:LMFT, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-1579
Mailing Address - Country:US
Mailing Address - Phone:310-969-9722
Mailing Address - Fax:
Practice Address - Street 1:2815 HOWARD RD
Practice Address - Street 2:STE. G
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260
Practice Address - Country:US
Practice Address - Phone:360-969-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60474081106H00000X
CAIMF 44006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist