Provider Demographics
NPI:1639598626
Name:HORTON, MONIQUE RACHELLE (LCMFT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:RACHELLE
Last Name:HORTON
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:RACHELLE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMFT
Mailing Address - Street 1:8911 E ORME ST STE D
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-2424
Mailing Address - Country:US
Mailing Address - Phone:316-247-1432
Mailing Address - Fax:316-425-7779
Practice Address - Street 1:8911 E ORME ST STE D
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-2424
Practice Address - Country:US
Practice Address - Phone:316-247-1432
Practice Address - Fax:316-425-7779
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201127960AMedicaid