Provider Demographics
NPI:1912369331
Name:HORN, TIMOTHY REID (MS, LPC-MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:REID
Last Name:HORN
Suffix:
Gender:M
Credentials:MS, LPC-MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HICKORY HILL LN STE 3
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1931
Mailing Address - Country:US
Mailing Address - Phone:615-892-1788
Mailing Address - Fax:
Practice Address - Street 1:1004 HICKORY HILL LN STE 3
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1931
Practice Address - Country:US
Practice Address - Phone:615-892-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4273101YP2500X
MO2015028809101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health