Provider Demographics
NPI:1518354463
Name:HORNER, MATTHEW (PSYD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HORNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 872841
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2841
Mailing Address - Country:US
Mailing Address - Phone:406-209-8933
Mailing Address - Fax:877-540-0156
Practice Address - Street 1:3771 N ENGSTROM RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:406-209-8933
Practice Address - Fax:877-540-0156
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY61266436103T00000X
AK147112103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK870OtherPROFESSIONAL COUNSELOR