Provider Demographics
NPI:1790820470
Name:HORTON, DARRELL WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:WAYNE
Last Name:HORTON
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 1:1201 W INDUSTRIAL
Mailing Address - Street 2:
Mailing Address - City:SULPHER SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482
Mailing Address - Country:US
Mailing Address - Phone:903-439-1990
Mailing Address - Fax:903-438-1405
Practice Address - Street 1:1201 W INDUSTRIAL
Practice Address - Street 2:
Practice Address - City:SULPHER SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482
Practice Address - Country:US
Practice Address - Phone:903-439-1990
Practice Address - Fax:903-438-1405
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23347103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0052EPOtherBLUE CROSS BLUE SHIELD
TX096465201Medicaid
TX096465201Medicaid