Provider Demographics
NPI:1033201991
Name:HORNER, JONATHAN N (MSED)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:N
Last Name:HORNER
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WPB VAMC MAIL CODE 116
Mailing Address - Street 2:7305 N MILITARY TRAIL
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-422-5306
Mailing Address - Fax:561-422-8686
Practice Address - Street 1:7305 N MILITARY TRAIL
Practice Address - Street 2:WPB VAMC MAIL CODE 116
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-422-5306
Practice Address - Fax:561-422-8686
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2952101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)