Provider Demographics
NPI:1962461251
Name:HOUCHEN, DANA BROOK (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:BROOK
Last Name:HOUCHEN
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:D
Other - Middle Name:BROOK
Other - Last Name:HOUCHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:1999 N AMIDON
Mailing Address - Street 2:STE 210
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2123
Mailing Address - Country:US
Mailing Address - Phone:316-831-0999
Mailing Address - Fax:316-831-0998
Practice Address - Street 1:1999 N AMIDON
Practice Address - Street 2:STE 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2123
Practice Address - Country:US
Practice Address - Phone:316-831-0999
Practice Address - Fax:316-831-0998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068583Medicare ID - Type Unspecified