MEDICARE: MRS. GAYLE P HORN

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	101YM0800X	Mental Health Counselor	000948	MO

General Provider Information

NPI Number	:	1376642256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAYLE P HORN

Provider Business Mailing Address
First Line	:	58 PORTWEST COURT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303
Country	:	US
Telephone Number	:	636-916-5800
Fax Number	:	636-916-0146

Provider Business Practice Location Address
First Line	:	58 PORTWEST CT
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-5985
Country	:	US
Telephone Number	:	636-916-5800
Fax Number	:	636-916-0146

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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