Healthcare Provider Details

I. General information

NPI: 1487926044
Provider Name (Legal Business Name): JEREMY THOMAS HORN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2012
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BOURNE AVE
SOMERSET KY
42501-2102
US

IV. Provider business mailing address

220 SCARLETS WAY
BRONSTON KY
42518-9611
US

V. Phone/Fax

Practice location:
  • Phone: 606-341-0277
  • Fax:
Mailing address:
  • Phone: 606-341-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCPCC00222202
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: