1053502203 NPI number — MS. KACEY LEIGH HORVATH-RIORDAN M.S., LMHC

Table of content: MS. KACEY LEIGH HORVATH-RIORDAN M.S., LMHC (NPI 1053502203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053502203 NPI number — MS. KACEY LEIGH HORVATH-RIORDAN M.S., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORVATH-RIORDAN
Provider First Name:
KACEY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HORVATH
Provider Other First Name:
LEIGH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053502203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3494 HIGHWAY 90 E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESTVIEW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32539-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-373-7321
Provider Business Mailing Address Fax Number:
850-689-3456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1473 AMMONS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE DE LEON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32455-8208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-373-7321
Provider Business Practice Location Address Fax Number:
850-689-3456
Provider Enumeration Date:
08/05/2007

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:  MH 9149 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 768485100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12139002 . This is a "CAQH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 768485100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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