MEDICARE: DEBRA HOFFMANN HOUST PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	P.07971	OH

General Provider Information

NPI Number	:	1164999280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA HOFFMANN HOUST PHD

Provider Business Mailing Address
First Line	:	MEDICAL DEPARTMENT
Second Line	:	USS CARL VINSON CVN 70
City	:	FPO
State	:	AP
Zip	:	96629-2840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL DEPARTMENT
Second Line	:	USS CARL VINSON CVN 70
City	:	FPO
State	:	AP
Zip	:	96629-2840
Country	:	US
Telephone Number	:	757-953-5814
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	03/20/2020

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