Healthcare Provider Details

I. General information

NPI: 1245779198
Provider Name (Legal Business Name): AMANDA LYANN HORVET BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 W NORTH AVE STE C
FLORA IL
62839-1293
US

IV. Provider business mailing address

832 W NORTH AVE STE C
FLORA IL
62839-1293
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-8494
  • Fax: 618-662-9519
Mailing address:
  • Phone: 618-662-8494
  • Fax: 618-662-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-58878
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: