Provider Demographics
NPI:1124341292
Name:DEEL-HOUT, AMY (MS, LCPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DEEL-HOUT
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IL
Mailing Address - Zip Code:62448-1736
Mailing Address - Country:US
Mailing Address - Phone:618-783-4154
Mailing Address - Fax:618-783-2339
Practice Address - Street 1:106 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IL
Practice Address - Zip Code:62448-1736
Practice Address - Country:US
Practice Address - Phone:618-783-4154
Practice Address - Fax:618-783-2339
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional