Healthcare Provider Details

I. General information

NPI: 1871330464
Provider Name (Legal Business Name): MICHELLE HORNER, PSYD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

IV. Provider business mailing address

661 W LAKE ST STE 2S
CHICAGO IL
60661-1034
US

V. Phone/Fax

Practice location:
  • Phone: 312-834-4245
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MICHELLE L HORNER
Title or Position: OWNER
Credential: PSYD
Phone: 312-834-4245