Provider Demographics
NPI:1699861807
Name:HOUCK, ROBERT LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:HOUCK
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:PO BOX 1998
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-1998
Mailing Address - Country:US
Mailing Address - Phone:828-898-2079
Mailing Address - Fax:
Practice Address - Street 1:1161 BALM HWY
Practice Address - Street 2:
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-9499
Practice Address - Country:US
Practice Address - Phone:828-898-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000004Medicaid