Healthcare Provider Details

I. General information

NPI: 1285348748
Provider Name (Legal Business Name): MCKENZIE M HORTON STUDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date: 09/30/2025
Reactivation Date: 01/28/2026

III. Provider practice location address

986 TENNESSEE RIDGE RD
LIBERTY KY
42539-8978
US

IV. Provider business mailing address

986 TENNESSEE RIDGE RD
LIBERTY KY
42539-8978
US

V. Phone/Fax

Practice location:
  • Phone: 606-875-9669
  • Fax:
Mailing address:
  • Phone: 606-875-9669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSTUDENT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: