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General NPI Number Information
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NPI Number | 1760159974
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Entity Type | Individual
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Provider Name | MYKALA HOUSEBURG LISW
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Gender | Female
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 12395 MCCRACKEN RD STE A-UP
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2967
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Country | US
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Telephone | 216-587-6727
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Fax |
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Provider Business Mailing Address
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Address Line | 1650 CEDARWOOD DR APT 338
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City | WESTLAKE
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State | OH
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Zip | 44145-1827
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.2506794
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License Number State | OH
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