Provider Demographics
NPI:1659433878
Name:HORINE, JAMES EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:HORINE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112
Mailing Address - Country:US
Mailing Address - Phone:816-931-9912
Mailing Address - Fax:816-561-5352
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 217
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112
Practice Address - Country:US
Practice Address - Phone:816-931-9912
Practice Address - Fax:816-561-5352
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00840103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
08725014OtherBCBSKC
MO0004040AMedicare ID - Type Unspecified