Provider Demographics
NPI:1922864297
Name:HOUSLEY, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HOUSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11312 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3904
Mailing Address - Country:US
Mailing Address - Phone:360-921-0482
Mailing Address - Fax:
Practice Address - Street 1:11312 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-3904
Practice Address - Country:US
Practice Address - Phone:360-921-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician