Provider Demographics
NPI:1710291109
Name:HORTON, STEPHANIE ELLEN (MA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ELLEN
Last Name:HORTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 SW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-6816
Mailing Address - Country:US
Mailing Address - Phone:918-577-7027
Mailing Address - Fax:
Practice Address - Street 1:914 SW 9TH ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-6816
Practice Address - Country:US
Practice Address - Phone:918-577-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health