Provider Demographics
NPI:1851952980
Name:NN HORTON PHD MHP LLC
Entity Type:Organization
Organization Name:NN HORTON PHD MHP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:N
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-672-3841
Mailing Address - Street 1:210 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2312
Mailing Address - Country:US
Mailing Address - Phone:601-672-3841
Mailing Address - Fax:601-707-7291
Practice Address - Street 1:210 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2312
Practice Address - Country:US
Practice Address - Phone:601-672-3841
Practice Address - Fax:601-707-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1144439811OtherBCBS