Provider Demographics
NPI:1174952030
Name:CEBALLOS-HOUTS, GLADIS (LLPC)
Entity type:Individual
Prefix:MRS
First Name:GLADIS
Middle Name:
Last Name:CEBALLOS-HOUTS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1118
Mailing Address - Country:US
Mailing Address - Phone:269-323-1954
Mailing Address - Fax:269-323-4183
Practice Address - Street 1:5805 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1118
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:269-323-4183
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health