Provider Demographics
NPI:1669993200
Name:HOUGHTALING, MARY (LMSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOUGHTALING
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 HIGHWAY 25
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:50849-8038
Mailing Address - Country:US
Mailing Address - Phone:610-308-1280
Mailing Address - Fax:
Practice Address - Street 1:1207 SUNNYSIDE LN STE D
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-2229
Practice Address - Country:US
Practice Address - Phone:712-243-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0873241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical