Provider Demographics
NPI:1508268145
Name:HORTON, PAULETTE
Entity Type:Individual
Prefix:MISS
First Name:PAULETTE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:13888 WINDING POND LN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-7102
Mailing Address - Country:US
Mailing Address - Phone:313-433-6315
Mailing Address - Fax:
Practice Address - Street 1:13888 WING POND LN
Practice Address - Street 2:
Practice Address - City:BELVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-7102
Practice Address - Country:US
Practice Address - Phone:313-433-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171M00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator