Provider Demographics
NPI:1396939641
Name:HOUTZER, EILEEN ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:ANN
Last Name:HOUTZER
Suffix:
Gender:F
Credentials:MFT
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 817
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-0817
Mailing Address - Country:US
Mailing Address - Phone:714-296-5366
Mailing Address - Fax:
Practice Address - Street 1:1548 NEWLAND DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3489
Practice Address - Country:US
Practice Address - Phone:714-296-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAMFC39869106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program