Healthcare Provider Details

I. General information

NPI: 1952686412
Provider Name (Legal Business Name): DR. DANA HOUCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22935 FARWELL AVE
FARIBAULT MN
55021-7885
US

IV. Provider business mailing address

22935 FARWELL AVE 22935
FARIBAULT MN
55021-7885
US

V. Phone/Fax

Practice location:
  • Phone: 507-685-4662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01103
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: