Provider Demographics
NPI:1023219532
Name:VAN HORN, CHARLEEN MARIE (LAC, LMP)
Entity Type:Individual
Prefix:
First Name:CHARLEEN
Middle Name:MARIE
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:LAC, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 167TH PL SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8002
Mailing Address - Country:US
Mailing Address - Phone:360-282-4014
Mailing Address - Fax:360-282-4017
Practice Address - Street 1:110 CEDAR AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2900
Practice Address - Country:US
Practice Address - Phone:360-282-4014
Practice Address - Fax:360-282-4017
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist