Healthcare Provider Details

I. General information

NPI: 1184288433
Provider Name (Legal Business Name): NATHAN MICHAEL HORTON BA, BSW, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE STE 300
JACKSON MI
49202-2180
US

IV. Provider business mailing address

1200 N WEST AVE STE 300
JACKSON MI
49202-2180
US

V. Phone/Fax

Practice location:
  • Phone: 517-789-1234
  • Fax: 517-740-7040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801099999
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: