Provider Demographics
NPI:1851630222
Name:DONALD E. HORTON, LLC
Entity Type:Organization
Organization Name:DONALD E. HORTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:651-646-2829
Mailing Address - Street 1:1053 LOVELL AVE W
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-4424
Mailing Address - Country:US
Mailing Address - Phone:651-646-2829
Mailing Address - Fax:
Practice Address - Street 1:1053 LOVELL AVE W
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-4424
Practice Address - Country:US
Practice Address - Phone:651-646-2829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00720261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)