Healthcare Provider Details

I. General information

NPI: 1699861807
Provider Name (Legal Business Name): ROBERT LEE HOUCK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 BALM HWY
BANNER ELK NC
28604-9499
US

IV. Provider business mailing address

PO BOX 1998
BANNER ELK NC
28604-1998
US

V. Phone/Fax

Practice location:
  • Phone: 828-898-2079
  • Fax:
Mailing address:
  • Phone: 828-898-2079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: