Healthcare Provider Details

I. General information

NPI: 1982018321
Provider Name (Legal Business Name): CHAD HOUCHIN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST ATTN: 21 OMRS/SGOW - MENTAL HEALTH
PETERSON AFB CO
80914-1540
US

IV. Provider business mailing address

559 VINCENT ST ATTN: 21 OMRS/SGOW - MENTAL HEALTH
PETERSON AFB CO
80914-1540
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-8581
  • Fax: 877-813-1756
Mailing address:
  • Phone: 719-556-8581
  • Fax: 877-813-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number810005011
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005011
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: