Healthcare Provider Details

I. General information

NPI: 1801971791
Provider Name (Legal Business Name): BRENT A HORLOCK MS, LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W WILSON ST STE 13
BATAVIA IL
60510-2997
US

IV. Provider business mailing address

804 CARLISLE RD
BATAVIA IL
60510-3023
US

V. Phone/Fax

Practice location:
  • Phone: 630-464-4104
  • Fax: 630-869-5350
Mailing address:
  • Phone: 630-464-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-003217
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: