Healthcare Provider Details

I. General information

NPI: 1962789610
Provider Name (Legal Business Name): MS. THERESE ANN HORTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESE ANN FORREST-HALL

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD STE 700
GLENDALE CA
91203-2336
US

IV. Provider business mailing address

1060 HARBOR HEIGHTS DR UNIT G
HARBOR CITY CA
90710-3094
US

V. Phone/Fax

Practice location:
  • Phone: 916-233-8634
  • Fax:
Mailing address:
  • Phone: 916-233-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: