Provider Demographics
NPI:1831470525
Name:HORTON, YASMIN (SAC)
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 N GRANDVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-6105
Mailing Address - Country:US
Mailing Address - Phone:262-549-6600
Mailing Address - Fax:262-549-6698
Practice Address - Street 1:2240 PRAIRE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2940
Practice Address - Country:US
Practice Address - Phone:262-549-6600
Practice Address - Fax:262-549-6698
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI155831630101YA0400X
WI15799131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)