Provider Demographics
NPI:1700449659
Name:KHOU, CHRISTINA SOUV (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SOUV
Last Name:KHOU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KHOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1645 W JACKSON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3244
Mailing Address - Country:US
Mailing Address - Phone:312-942-5932
Mailing Address - Fax:312-942-4990
Practice Address - Street 1:1645 W JACKSON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3244
Practice Address - Country:US
Practice Address - Phone:312-942-5932
Practice Address - Fax:312-942-4990
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010318103T00000X
103TH0004X
IL071-010318103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth