Provider Demographics
NPI:1366961971
Name:LARSON-HOUCK, JADE KAY-MARIE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:KAY-MARIE
Last Name:LARSON-HOUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 SPENCER ST STE A48
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5245
Mailing Address - Country:US
Mailing Address - Phone:702-483-0190
Mailing Address - Fax:
Practice Address - Street 1:4045 SPENCER ST STE A48
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5245
Practice Address - Country:US
Practice Address - Phone:702-483-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1630104100000X
NV10297-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker