Healthcare Provider Details

I. General information

NPI: 1851586937
Provider Name (Legal Business Name): GEORGE ROBERT HORTON PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

708 GLENEAGLES DR.
EDMOND OK
73013-7005
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-3635
  • Fax:
Mailing address:
  • Phone: 405-570-0809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1175
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: