1306376454 NPI number — CHRISTINE ELLEN RENEE HORNER MA, BCBA

Table of content: CHRISTINE ELLEN RENEE HORNER MA, BCBA (NPI 1306376454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306376454 NPI number — CHRISTINE ELLEN RENEE HORNER MA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNER
Provider First Name:
CHRISTINE
Provider Middle Name:
ELLEN RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, BCBA
Provider Gender Code:
F

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:
1306376454
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 PEACHTREE ST NW STE 2200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30303-1292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-324-0885
Provider Business Mailing Address Fax Number:
317-520-8200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 MCKINNON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKSPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04416-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-814-8542
Provider Business Practice Location Address Fax Number:
207-261-1124
Provider Enumeration Date:
06/12/2017

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: 103K00000X , with the licence number:  4001 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1-18-31523 . This is a "BCBA ONLY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0133002733 . This is a "LICENSED BEHAVIOR ANALYST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4001 . This is a "LICENSED BEHAVIOR ANALYST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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