MEDICARE: ISAAC HORTON

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	LPC-15170	AZ

General Provider Information

NPI Number	:	1336547405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAAC HORTON

Provider Business Mailing Address
First Line	:	5010 E CHEYENNE DRIVE
Second Line	:	#1065
City	:	PHOENIX
State	:	AZ
Zip	:	85044
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 E CHEYENNE DR
Second Line	:	#1065
City	:	PHOENIX
State	:	AZ
Zip	:	85044-1770
Country	:	US
Telephone Number	:	470-333-8938
Fax Number	:

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

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	12/05/2014

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Directions to “ ISAAC HORTON ” Practice Location

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