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General NPI Number Information
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NPI Number | 1326965104
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Entity Type | Individual
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Provider Name | KELLYE MICHELLE HOUCK
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Gender | Female
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 17000 VENTURA BLVD STE 102
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City | ENCINO
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State | CA
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Zip | 91316-4149
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Country | US
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Telephone | 928-371-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 1785 W STATE ROUTE 89A STE 1D
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City | SEDONA
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State | AZ
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Zip | 86336-5559
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Country | US
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Telephone | 928-371-3885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 14765
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 96145
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License Number State | CA
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