Provider Demographics
NPI:1790872034
Name:HORNER, DONALD RAY (LLP)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:HORNER
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 S SHORE DR STE 214
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014-5446
Mailing Address - Country:US
Mailing Address - Phone:269-964-0153
Mailing Address - Fax:855-877-5812
Practice Address - Street 1:391 S SHORE DR STE 214
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5446
Practice Address - Country:US
Practice Address - Phone:269-781-9119
Practice Address - Fax:269-781-7872
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005471103T00000X
MI6361004266103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000006550OtherPHYSICIANS HEALTH PLAN
MI7509107630OtherBCBS OF MI