Healthcare Provider Details

I. General information

NPI: 1679367064
Provider Name (Legal Business Name): KATIE HOUX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 TELLBROOK RD APT 1
LAS CRUCES NM
88011-2561
US

IV. Provider business mailing address

4060 TELLBROOK RD APT 1
LAS CRUCES NM
88011-2561
US

V. Phone/Fax

Practice location:
  • Phone: 915-479-7407
  • Fax:
Mailing address:
  • Phone: 915-479-7407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: