Provider Demographics
NPI:1063653616
Name:HORTON, JEANNETTE MAE (LMHC)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MAE
Last Name:HORTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JEANNETTE
Other - Middle Name:MAE
Other - Last Name:MEZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, CDP
Mailing Address - Street 1:PO BOX 45610
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98504-5610
Mailing Address - Country:US
Mailing Address - Phone:360-778-2449
Mailing Address - Fax:
Practice Address - Street 1:112 12TH STREET
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9656
Practice Address - Country:US
Practice Address - Phone:360-778-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60401133101YM0800X
WACP60115601101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)