Provider Demographics
NPI:1760690283
Name:HORN, RITA L
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:L
Last Name:HORN
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:P.O. BOX 220
Mailing Address - Street 2:
Mailing Address - City:HEART BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59448-0220
Mailing Address - Country:US
Mailing Address - Phone:406-338-6330
Mailing Address - Fax:
Practice Address - Street 1:CRYSTAL CREEK LODGE
Practice Address - Street 2:OLD HOSPITAL ROAD #1
Practice Address - City:BROWNING
Practice Address - State:TN
Practice Address - Zip Code:59417-0000
Practice Address - Country:US
Practice Address - Phone:406-338-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1009101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)