MEDICARE: ELISA HORTON, LMFT, LMHC, NCC, INC

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	MH8749	FL
2	106H00000X	Marriage & Family Therapist	MT2182	FL

General Provider Information

NPI Number	:	1932403599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELISA HORTON, LMFT, LMHC, NCC, INC

Provider Business Mailing Address
First Line	:	901 SW MARTIN DOWNS BLVD
Second Line	:	STE. 317
City	:	PALM CITY
State	:	FL
Zip	:	34990-2862
Country	:	US
Telephone Number	:	772-426-9955
Fax Number	:	772-781-8388

Provider Business Practice Location Address
First Line	:	901 SW MARTIN DOWNS BLVD
Second Line	:	STE. 317
City	:	PALM CITY
State	:	FL
Zip	:	34990-2862
Country	:	US
Telephone Number	:	772-426-9955
Fax Number	:	772-781-8388

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ELISA HORTON
Credential	:	LMFT, LMHC, NCC
Telephone Number	:	772-426-9955

Provider Enumeration Date	:	12/22/2010
Last Update Date	:	01/18/2013

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