Healthcare Provider Details

I. General information

NPI: 1578155685
Provider Name (Legal Business Name): MALLORY L HORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6241 HAAG ST APT B
FORT POLK LA
71459-7420
US

IV. Provider business mailing address

6241 HAAG ST APT B
FORT POLK LA
71459-7420
US

V. Phone/Fax

Practice location:
  • Phone: 501-482-1510
  • Fax:
Mailing address:
  • Phone: 501-482-1510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03268
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.10146
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: