Provider Demographics
NPI:1851713697
Name:HORNAK, NANCY JOAN (LP)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JOAN
Last Name:HORNAK
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W MICHIGAN ST STE 12
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2492
Mailing Address - Country:US
Mailing Address - Phone:989-317-4664
Mailing Address - Fax:
Practice Address - Street 1:304 W MICHIGAN ST STE 12
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2492
Practice Address - Country:US
Practice Address - Phone:989-317-4664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000999101YP2500X
MI6301005952103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional