Provider Demographics
NPI:1912204546
Name:GREENE, HORIZON (LICSW)
Entity Type:Individual
Prefix:
First Name:HORIZON
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1200 112TH AVE NE STE B100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3751
Practice Address - Country:US
Practice Address - Phone:425-462-1132
Practice Address - Fax:425-456-3668
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW609849451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1912204546Medicaid
WA1912204546Medicaid
OR1912204546OtherOTHER