1326466053 NPI number — MARY RENATTE HORN LMHC

Table of content: MARY RENATTE HORN LMHC (NPI 1326466053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326466053 NPI number — MARY RENATTE HORN LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORN
Provider First Name:
MARY
Provider Middle Name:
RENATTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TORRES
Provider Other First Name:
MARY
Provider Other Middle Name:
RENATTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326466053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
36 WOOD AMBER LN UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32164-7960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-335-7429
Provider Business Mailing Address Fax Number:
888-977-1564

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9445 NE BUSINESS PARK LN STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE ISLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98110-4634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-335-7429
Provider Business Practice Location Address Fax Number:
888-977-1564
Provider Enumeration Date:
03/31/2014

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:  LH60546279 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2233074 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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