MEDICARE: KELLY JEAN O'HORO MC

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

General Provider Information

NPI Number	:	1801105754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JEAN O'HORO MC

Provider Business Mailing Address
First Line	:	2563 S VAL VISTA DR
Second Line	:	SUITE 108
City	:	GILBERT
State	:	AZ
Zip	:	85295-1804
Country	:	US
Telephone Number	:	480-448-1076
Fax Number	:

Provider Business Practice Location Address
First Line	:	2563 S VAL VISTA DR
Second Line	:	SUITE 108
City	:	GILBERT
State	:	AZ
Zip	:	85295-1804
Country	:	US
Telephone Number	:	480-448-1076
Fax Number	:

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	03/26/2014

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