MEDICARE: KEN HORROCKS COUNSELING LLC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	000115	VT

General Provider Information

NPI Number	:	1144522392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEN HORROCKS COUNSELING LLC

Provider Business Mailing Address
First Line	:	1 MILL ST
Second Line	:	SUITE 175
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1530
Country	:	US
Telephone Number	:	802-399-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MILL ST
Second Line	:	SUITE 175
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1530
Country	:	US
Telephone Number	:	802-399-9112
Fax Number	:

Authorized Official
Title or Position	:	SUBSTANCE ABUSE COUNSELOR
Name	:	MR. KEN HORROCKS
Credential	:	LADC
Telephone Number	:	802-399-9112

Provider Enumeration Date	:	11/20/2010
Last Update Date	:	11/20/2010

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