Provider Demographics
NPI:1053502203
Name:HORVATH-RIORDAN, KACEY LEIGH (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:KACEY
Middle Name:LEIGH
Last Name:HORVATH-RIORDAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:HORVATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3494 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5102
Mailing Address - Country:US
Mailing Address - Phone:850-373-7321
Mailing Address - Fax:850-689-3456
Practice Address - Street 1:1473 AMMONS RD
Practice Address - Street 2:
Practice Address - City:PONCE DE LEON
Practice Address - State:FL
Practice Address - Zip Code:32455-8208
Practice Address - Country:US
Practice Address - Phone:850-373-7321
Practice Address - Fax:850-689-3456
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768485100Medicaid
FL12139002OtherCAQH