MEDICARE: DR. JO ANN HOUTS

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	22379	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87108A	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770512691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JO ANN HOUTS

Provider Business Mailing Address
First Line	:	6201 YOLANDA DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-4069
Country	:	US
Telephone Number	:	817-994-7269
Fax Number	:	817-492-4184

Provider Business Practice Location Address
First Line	:	2129 SKYLINE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1924
Country	:	US
Telephone Number	:	800-257-8715
Fax Number	:	800-819-1655

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JO ANN HOUTS ” Practice Location

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