Provider Demographics
NPI:1720324866
Name:HOUDE, DEBRA (MA)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:HOUDE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9029 N PHEASANT RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9170
Mailing Address - Country:US
Mailing Address - Phone:734-330-8911
Mailing Address - Fax:
Practice Address - Street 1:9029 N PHEASANT RIDGE LN
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9170
Practice Address - Country:US
Practice Address - Phone:734-330-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-18
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical