Provider Demographics
NPI:1376766907
Name:HORAN-SAPUNAR, THERESA (IMFT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HORAN-SAPUNAR
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WHITEHALL DR
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1936
Mailing Address - Country:US
Mailing Address - Phone:937-767-8897
Mailing Address - Fax:
Practice Address - Street 1:4144 CROSSGATE LN # R
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-1216
Practice Address - Country:US
Practice Address - Phone:513-791-7915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0000081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist