Provider Demographics
NPI:1457997900
Name:VANHOUSEN, KIRK (LCDC INTERN)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:VANHOUSEN
Suffix:
Gender:M
Credentials:LCDC INTERN
Other - Prefix:
Other - First Name:KIRK
Other - Middle Name:
Other - Last Name:VANHOUSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:247 E SOUTHWEST PKWY APT 416
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8728
Mailing Address - Country:US
Mailing Address - Phone:817-489-0026
Mailing Address - Fax:
Practice Address - Street 1:621 LONDONDERRY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7792
Practice Address - Country:US
Practice Address - Phone:940-483-0644
Practice Address - Fax:940-483-9337
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41318101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherDO NOT HAVE