Provider Demographics
NPI:1497108187
Name:HORTON, MAEGEN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:MAEGEN
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3152
Mailing Address - Country:US
Mailing Address - Phone:307-438-9744
Mailing Address - Fax:
Practice Address - Street 1:315 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3152
Practice Address - Country:US
Practice Address - Phone:307-438-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional