MEDICARE: KELLY HORWOOD

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	101YP2500X	Professional Counselor	A13988	NC
2	101YP2500X	Professional Counselor	6858	SC

General Provider Information

NPI Number	:	1295211993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY HORWOOD

Provider Business Mailing Address
First Line	:	652 BUSH RIVER RD STE 216
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7537
Country	:	US
Telephone Number	:	803-851-5252
Fax Number	:

Provider Business Practice Location Address
First Line	:	652 BUSH RIVER RD STE 216
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7537
Country	:	US
Telephone Number	:	803-851-5252
Fax Number	:

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

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	07/16/2018

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Directions to “ KELLY HORWOOD ” Practice Location

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