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General NPI Number Information
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NPI Number | 1578262010
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Entity Type | Individual
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Provider Name | JASMIN RANE HORNE LPC-IT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 115 N CENTER ST
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City | BEAVER DAM
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State | WI
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Zip | 53916-2119
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Country | US
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Telephone | 392-887-1766
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Fax | 920-887-2322
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Provider Business Mailing Address
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Address Line | 604 N MAIN ST
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City | FALL RIVER
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State | WI
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Zip | 53932-9570
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Country | US
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Telephone | 920-344-1516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 7248-226
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License Number State | WI
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