Provider Demographics
NPI:1326466053
Name:HORN, MARY RENATTE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:RENATTE
Last Name:HORN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:RENATTE
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:36 WOOD AMBER LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7960
Mailing Address - Country:US
Mailing Address - Phone:206-335-7429
Mailing Address - Fax:888-977-1564
Practice Address - Street 1:26812 118TH AVE E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-9220
Practice Address - Country:US
Practice Address - Phone:206-335-7429
Practice Address - Fax:888-977-1564
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-31
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60546279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2233074Medicaid