Provider Demographics
NPI:1952486011
Name:HOULE, MICHAEL (LCSWCADCIII)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HOULE
Suffix:
Gender:M
Credentials:LCSWCADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6121 GREEN BAY RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2926
Mailing Address - Country:US
Mailing Address - Phone:262-654-8366
Mailing Address - Fax:
Practice Address - Street 1:6121 GREEN BAY RD
Practice Address - Street 2:SUITE 230
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2926
Practice Address - Country:US
Practice Address - Phone:262-654-8366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12151101YA0400X
WI1558-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical