Provider Demographics
NPI:1326568585
Name:HORTON, LEEANN MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:LEEANN
Middle Name:MARIE
Last Name:HORTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 CAMPBELL LN STE 600
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3390
Mailing Address - Country:US
Mailing Address - Phone:270-715-1178
Mailing Address - Fax:270-715-1189
Practice Address - Street 1:1440 CAMPBELL LN STE 600
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3390
Practice Address - Country:US
Practice Address - Phone:270-715-1178
Practice Address - Fax:270-715-1189
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY173210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100487840Medicaid