Provider Demographics
NPI:1417693664
Name:HORIZON WEST COUNSELING, PLLC
Entity Type:Organization
Organization Name:HORIZON WEST COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MICELI
Authorized Official - Suffix:
Authorized Official - Credentials:EDD LCSW
Authorized Official - Phone:407-906-4352
Mailing Address - Street 1:3065 DANIELS RD # 1414
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-7002
Mailing Address - Country:US
Mailing Address - Phone:407-906-4352
Mailing Address - Fax:
Practice Address - Street 1:16830 WINGSPREAD LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9550
Practice Address - Country:US
Practice Address - Phone:617-501-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health