Provider Demographics
NPI:1760054035
Name:HORSTMAN, PRESTON LEE JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:LEE
Last Name:HORSTMAN
Suffix:JR
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0837
Mailing Address - Country:US
Mailing Address - Phone:580-670-1842
Mailing Address - Fax:
Practice Address - Street 1:21721 76TH AVENUE WEST
Practice Address - Street 2:SUITE C/D
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-9836
Practice Address - Country:US
Practice Address - Phone:580-670-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0735103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral