Provider Demographics
NPI:1235614116
Name:HORN, MICHELLE ANN (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:HORN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W ROBINHOOD DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5512
Mailing Address - Country:US
Mailing Address - Phone:209-561-9859
Mailing Address - Fax:
Practice Address - Street 1:1350 W ROBINHOOD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5512
Practice Address - Country:US
Practice Address - Phone:209-561-9859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT136019106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT136019Medicaid