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General NPI Number Information
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NPI Number | 1528230919
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Entity Type | Organization
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Legal Business Name | KELLY HORTON, PSY.D.
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 631 TENNESSEE ST
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City | VALLEJO
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State | CA
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Zip | 94590-4432
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Country | US
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Telephone | 707-362-0456
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Fax | 707-552-1050
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Provider Business Mailing Address
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Address Line | PO BOX 888
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City | VALLEJO
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State | CA
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Zip | 94590-0088
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Country | US
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Telephone | 707-362-0456
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Fax | 707-552-1050
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. KELLY HORTON
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Credential | PSY.D.
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Telephone | 707-362-0456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY20970
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License Number State | CA
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