Active NPI
Brandon M Houk, LMHC
- Mental Health Counselor
- St Augustine, FL
National Provider Identifier
1730284530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- MH12288
- Practice address
- 2200 N Ponce de Leon Blvd Ste 4
St Augustine, FL 32084-2650 - Phone
- (208) 716-0425
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LPC3487 | ID | |
| Mental Health Counselor | 101YM0800X | MH12288 | FL | Primary |
Addresses
Primary practice location
2200 N Ponce de Leon Blvd Ste 4
St Augustine, FL 32084-2650
Mailing address
2200 N Ponce de Leon Blvd Ste 4
St Augustine, FL 32084-2650
Phone (208) 716-0425
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002658300 | Medicaid | ID | |
| 820428306 | Other | ID | IDAHO PHYSICIANS NETWORK |
| 820428306 | Other | ID | TRICARE |
| X6882 | Other | ID | BLUE CROSS OF IDAHO |
| 000010151980 | Other | ID | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MH12288 | FL | MD | Mental Health Counselor |
| LPC3487 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448323200000",
"number": "1730284530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 N PONCE DE LEON BLVD STE 4",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320842650",
"telephone_number": "208-716-0425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 N PONCE DE LEON BLVD STE 4",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320842650",
"telephone_number": "208-716-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOUK",
"first_name": "BRANDON",
"middle_name": "M",
"name_prefix": "Mr.",
"credential": "LMHC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2015-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LPC3487",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "MH12288",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002658300",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO PHYSICIANS NETWORK",
"identifier": "820428306",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "820428306",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "X6882",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010151980",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.