Provider Demographics
NPI:1215223334
Name:HORNE, GLENDA MARIE (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:MARIE
Last Name:HORNE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1589 AMBERLEA DR N
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-4733
Mailing Address - Country:US
Mailing Address - Phone:727-542-4834
Mailing Address - Fax:
Practice Address - Street 1:2460 NORTHSIDE DR APT 1303
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2242
Practice Address - Country:US
Practice Address - Phone:727-542-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1062922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691662796OtherMEDICAID WAIVER
FL691662798OtherMEDICAID FAMILY WAIVER