Healthcare Provider Details

I. General information

NPI: 1851947964
Provider Name (Legal Business Name): SEBASTIAN GEORGE HORTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 COMANCHE ST
BONNERS FERRY ID
83805-7523
US

IV. Provider business mailing address

3661 W PANDION DR
COEUR D ALENE ID
83815-6004
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-1718
  • Fax: 208-267-9197
Mailing address:
  • Phone: 208-627-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-7138
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-7138
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: