Individual
MS. PATRICIA JUAN HOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1104 E 35TH ST, INDIANAPOLIS, IN 46205-3601
(317) 372-1015
(317) 253-7388
Mailing address
PO BOX 88824, INDIANAPOLIS, IN 46208-0824
(317) 372-1015
(317) 253-7388
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34001701A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221076
ANTHEM
IN
01
—
34001701A
STATE LICENSE NO
IN
Enumeration date
08/30/2006
Last updated
07/08/2007
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