Provider Demographics
NPI:1174647630
Name:HORTON, LYNN ELLEN (MFC)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ELLEN
Last Name:HORTON
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:MS
Other - First Name:LYNN
Other - Middle Name:ELLEN
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFC
Mailing Address - Street 1:30817 CALLE CHUECA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1605
Mailing Address - Country:US
Mailing Address - Phone:949-488-2884
Mailing Address - Fax:
Practice Address - Street 1:30817 CALLE CHUECA
Practice Address - Street 2:NA
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1605
Practice Address - Country:US
Practice Address - Phone:949-488-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30858OtherMFC