Provider Demographics
NPI:1154915452
Name:HOUT, MARK T
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:HOUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-8418
Mailing Address - Country:US
Mailing Address - Phone:970-356-1398
Mailing Address - Fax:970-356-1399
Practice Address - Street 1:2723 9TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8418
Practice Address - Country:US
Practice Address - Phone:970-356-1398
Practice Address - Fax:970-356-1399
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCL-01969171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications