Provider Demographics
NPI:1093769705
Name:HORWITZ, ELLEN A (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:A
Last Name:HORWITZ
Suffix:
Gender:F
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-6921
Mailing Address - Fax:573-882-1154
Practice Address - Street 1:402 N KEENE ST
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6986
Practice Address - Country:US
Practice Address - Phone:573-882-6921
Practice Address - Fax:573-882-1154
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01213103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7504019OtherUNITED HEALTHCARE
MO7460OtherBLUE SHIELD/BLUE CHOICE
MO259936OtherHEALTHLINK
MO493396303Medicaid
MO259936OtherHEALTHLINK
MO493396303Medicaid
MO000070313Medicare PIN