Provider Demographics
NPI:1326368655
Name:HORTON, EVELYNN L (LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYNN
Middle Name:L
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCSW
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 1043
Mailing Address - Street 2:
Mailing Address - City:EMMETT
Mailing Address - State:ID
Mailing Address - Zip Code:83617-1043
Mailing Address - Country:US
Mailing Address - Phone:208-740-9466
Mailing Address - Fax:
Practice Address - Street 1:113 N COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:EMMETT
Practice Address - State:ID
Practice Address - Zip Code:83617-2919
Practice Address - Country:US
Practice Address - Phone:208-398-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-278411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical