Provider Demographics
NPI:1366123572
Name:HOUVOURAS, ANDREW JOHN IV
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JOHN
Last Name:HOUVOURAS
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 BEDFORD DR STE B2
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1900
Mailing Address - Country:US
Mailing Address - Phone:321-622-8104
Mailing Address - Fax:
Practice Address - Street 1:1299 BEDFORD DR STE B2
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1900
Practice Address - Country:US
Practice Address - Phone:321-749-3267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-20515103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst