Provider Demographics
NPI:1407664154
Name:HOUGEN, CLINT CHRISTOPHER (PHD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:CHRISTOPHER
Last Name:HOUGEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SUTTON ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4482
Mailing Address - Country:US
Mailing Address - Phone:715-523-0091
Mailing Address - Fax:
Practice Address - Street 1:43 SUTTON ST APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4482
Practice Address - Country:US
Practice Address - Phone:715-523-0091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125018103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical