Provider Demographics
NPI:1043639990
Name:HORROCKS, MAYA (LM, CPM)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:HORROCKS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1660
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0130
Mailing Address - Country:US
Mailing Address - Phone:360-385-6667
Mailing Address - Fax:360-841-6650
Practice Address - Street 1:1001 WATER ST STE 1015
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6705
Practice Address - Country:US
Practice Address - Phone:360-385-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60442003176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2080604Medicaid