Provider Demographics
NPI:1073905758
Name:HORNER, BRENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:HORNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E BROADWAY STE 301
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3154
Mailing Address - Country:US
Mailing Address - Phone:541-206-7080
Mailing Address - Fax:
Practice Address - Street 1:132 E BROADWAY STE 301
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3154
Practice Address - Country:US
Practice Address - Phone:541-206-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2371103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling