MEDICARE: MR. KIPPER S HORTON MFT, LADC

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	00451P	NV
2	106H00000X	Marriage & Family Therapist	01323	NV

General Provider Information

NPI Number	:	1174827661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KIPPER S HORTON MFT, LADC

Provider Business Mailing Address
First Line	:	180 W HUFFAKER LN STE 303
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2091
Country	:	US
Telephone Number	:	775-621-8727
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 W HUFFAKER LN STE 303
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2091
Country	:	US
Telephone Number	:	775-621-8727
Fax Number	:

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

Provider Enumeration Date	:	12/27/2010
Last Update Date	:	07/05/2015

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