Provider Demographics
NPI:1366100430
Name:HOUSER, MITZI (LPC-SUPERVISED)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:HOUSER
Suffix:
Gender:F
Credentials:LPC-SUPERVISED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SE WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-7135
Mailing Address - Country:US
Mailing Address - Phone:918-335-1111
Mailing Address - Fax:
Practice Address - Street 1:2200 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7135
Practice Address - Country:US
Practice Address - Phone:918-335-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator