Provider Demographics
NPI:1619387495
Name:HORTON, TERRI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCSW
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 1616
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-1616
Mailing Address - Country:US
Mailing Address - Phone:951-743-3522
Mailing Address - Fax:
Practice Address - Street 1:27315 NORTH BAY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:BLUE JAY
Practice Address - State:CA
Practice Address - Zip Code:92317-5501
Practice Address - Country:US
Practice Address - Phone:909-336-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 218061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical