Healthcare Provider Details

I. General information

NPI: 1811276280
Provider Name (Legal Business Name): ELIZABETH ANN HORN MA, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 S PROGRESS AVE
MERIDIAN ID
83642-5619
US

IV. Provider business mailing address

PO BOX 45899
BOISE ID
83711-5899
US

V. Phone/Fax

Practice location:
  • Phone: 208-895-6729
  • Fax: 208-855-5921
Mailing address:
  • Phone: 208-895-6729
  • Fax: 208-855-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-3950
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: