Provider Demographics
NPI:1437429404
Name:HORTON, KRISTIN (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-2074
Mailing Address - Country:US
Mailing Address - Phone:517-416-0213
Mailing Address - Fax:
Practice Address - Street 1:2 CROCKER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2558
Practice Address - Country:US
Practice Address - Phone:586-468-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010923801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical