Provider Demographics
NPI:1659537108
Name:HORNER, JENNIFER REBECCA
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:HORNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 SUNRISE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7634
Mailing Address - Country:US
Mailing Address - Phone:916-239-6331
Mailing Address - Fax:916-344-0739
Practice Address - Street 1:5750 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7634
Practice Address - Country:US
Practice Address - Phone:916-344-0249
Practice Address - Fax:916-344-0964
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52632106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist