1538221205 NPI number — MR. MARK J HORAN LCMHC, LCPC

Table of content: MR. MARK J HORAN LCMHC, LCPC (NPI 1538221205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538221205 NPI number — MR. MARK J HORAN LCMHC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORAN
Provider First Name:
MARK
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC, LCPC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538221205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2726
Provider Second Line Business Mailing Address:
81 WASHINGTON ST.
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03818-2726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-447-2453
Provider Business Mailing Address Fax Number:
603-447-2450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03818-6044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-447-2453
Provider Business Practice Location Address Fax Number:
603-447-2450
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  315 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30424635 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com