Healthcare Provider Details

I. General information

NPI: 1922324953
Provider Name (Legal Business Name): KATHLEEN HOUSTON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 PINE ST
BURLINGTON VT
05401-5353
US

IV. Provider business mailing address

208 FLYNN AVE SUITE 3J
BURLINGTON VT
05401-5429
US

V. Phone/Fax

Practice location:
  • Phone: 802-488-6600
  • Fax: 802-488-6901
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068-0057495
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: