Healthcare Provider Details

I. General information

NPI: 1902581044
Provider Name (Legal Business Name): JESSICA HOUTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 SUNTREE BLVD STE 125
MELBOURNE FL
32940-7540
US

IV. Provider business mailing address

3270 SUNTREE BLVD STE 125
MELBOURNE FL
32940-7540
US

V. Phone/Fax

Practice location:
  • Phone: 321-207-6181
  • Fax:
Mailing address:
  • Phone: 321-207-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1143356
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019820
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20880
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: