Healthcare Provider Details

I. General information

NPI: 1376406264
Provider Name (Legal Business Name): AUTUMN RAE HORTON AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 CAMINO DEL RIO S STE 112
SAN DIEGO CA
92108-3546
US

IV. Provider business mailing address

438 CAMINO DEL RIO S STE 112
SAN DIEGO CA
92108-3546
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-6676
  • Fax:
Mailing address:
  • Phone: 619-787-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number159795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: