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General NPI Number Information
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NPI Number | 1922632900
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Entity Type | Organization
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Legal Business Name | JEREMY HOUTSMA COUNSELING LLC
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 02/27/2020
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Provider Practice Location Address
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Address Line | 601 MAIN ST STE 309
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City | VANCOUVER
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State | WA
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Zip | 98660-3404
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Country | US
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Telephone | 503-567-2689
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Fax |
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Provider Business Mailing Address
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Address Line | 13654 SE BUSH ST
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City | PORTLAND
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State | OR
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Zip | 97236-2936
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Country | US
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Telephone | 201-638-0704
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JEREMY HOUTSMA
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Credential | LMHC
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Telephone | 201-638-0704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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