Provider Demographics
NPI:1073606760
Name:DR MARY C HORN LLC
Entity Type:Organization
Organization Name:DR MARY C HORN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-247-2961
Mailing Address - Street 1:45-955 KAMEHAMEHA HWY
Mailing Address - Street 2:#306
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3222
Mailing Address - Country:US
Mailing Address - Phone:808-247-2961
Mailing Address - Fax:808-247-2962
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:#306
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-247-2961
Practice Address - Fax:808-247-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY755103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty