MEDICARE: DR. PAMELA HORNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	4052	AZ

General Provider Information

NPI Number	:	1144260258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA HORNER PH.D.

Provider Business Mailing Address
First Line	:	20470 N LAKE PLEASANT RD
Second Line	:	STE 106
City	:	PEORIA
State	:	AZ
Zip	:	85382-9708
Country	:	US
Telephone Number	:	623-584-7800
Fax Number	:	623-933-8625

Provider Business Practice Location Address
First Line	:	20470 N LAKE PLEASANT RD
Second Line	:	STE 106
City	:	PEORIA
State	:	AZ
Zip	:	85382-9708
Country	:	US
Telephone Number	:	623-584-7800
Fax Number	:	623-933-8625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	12/06/2016

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