Provider Demographics
NPI:1215431242
Name:HOULT, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HOULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W HARRISON
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61951
Mailing Address - Country:US
Mailing Address - Phone:217-728-4358
Mailing Address - Fax:
Practice Address - Street 1:12 W HARRISON
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951
Practice Address - Country:US
Practice Address - Phone:217-728-4358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health