Provider Demographics
NPI:1932219862
Name:HOUSE, PATRICIA JUAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JUAN
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LCSW
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 88824
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-0824
Mailing Address - Country:US
Mailing Address - Phone:317-372-1015
Mailing Address - Fax:317-253-7388
Practice Address - Street 1:1104 E 35TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3601
Practice Address - Country:US
Practice Address - Phone:317-372-1015
Practice Address - Fax:317-253-7388
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001701A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34001701AOtherSTATE LICENSE NO
IN000000221076OtherANTHEM
IN000000221076OtherANTHEM