Provider Demographics
NPI:1881843043
Name:HORST, GLEN ALLEN
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:ALLEN
Last Name:HORST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42035 47TH ST W
Mailing Address - Street 2:
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-3502
Mailing Address - Country:US
Mailing Address - Phone:661-943-2317
Mailing Address - Fax:
Practice Address - Street 1:42035 47TH ST W
Practice Address - Street 2:
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-3502
Practice Address - Country:US
Practice Address - Phone:661-943-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health