Provider Demographics
NPI:1376991828
Name:HORN, JACK JR (LPC)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:HORN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 LITTLE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-1835
Mailing Address - Country:US
Mailing Address - Phone:540-373-7954
Mailing Address - Fax:540-371-5362
Practice Address - Street 1:28 LITTLE FIELD DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-1835
Practice Address - Country:US
Practice Address - Phone:540-373-7954
Practice Address - Fax:540-371-5362
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional