Provider Demographics
NPI:1437588043
Name:HORTON, MICHAEL JAY (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:HORTON
Suffix:
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 1:24337 RAMBLER RD
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5531
Mailing Address - Country:US
Mailing Address - Phone:907-512-6969
Mailing Address - Fax:
Practice Address - Street 1:1840 BRAGAW ST STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3463
Practice Address - Country:US
Practice Address - Phone:907-334-0143
Practice Address - Fax:907-563-2891
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11-044-BHP101Y00000X
AK2886101YA0400X
AK616101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)