Provider Demographics
NPI:1982697124
Name:HOUCK, JOHN B (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:HOUCK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 BREAKERS DR APT 329
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1063
Mailing Address - Country:US
Mailing Address - Phone:773-493-1330
Mailing Address - Fax:
Practice Address - Street 1:3633 BREAKERS DR APT 329
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1063
Practice Address - Country:US
Practice Address - Phone:773-493-1330
Practice Address - Fax:707-549-4532
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071001927103T00000X, 103TC0700X
IL071-001927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071-001927OtherCLINICAL PSYCHOLOGIST LIC