Healthcare Provider Details

I. General information

NPI: 1780616334
Provider Name (Legal Business Name): KELLY L HORNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W MONUMENT SQ SUITE 206
LEWISTOWN PA
17044-2188
US

IV. Provider business mailing address

3 W MONUMENT SQ SUITE 206
LEWISTOWN PA
17044
US

V. Phone/Fax

Practice location:
  • Phone: 717-248-8197
  • Fax: 717-248-6449
Mailing address:
  • Phone: 717-248-8197
  • Fax: 717-248-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003071
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: