Healthcare Provider Details

I. General information

NPI: 1437321171
Provider Name (Legal Business Name): NICOLE T HORNE MFT-INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E FOOTHILL BLVD
RIALTO CA
92376-5230
US

IV. Provider business mailing address

26818 CALLE VEJAR
MORENO VALLEY CA
92555-4117
US

V. Phone/Fax

Practice location:
  • Phone: 909-421-9495
  • Fax: 909-421-9494
Mailing address:
  • Phone: 951-924-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: