Provider Demographics
NPI:1922533801
Name:HORIZON COMMUNITY CHURCH
Entity Type:Organization
Organization Name:HORIZON COMMUNITY CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE PASTOR AND LMFT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:PASTOR, LMFT
Authorized Official - Phone:209-744-2136
Mailing Address - Street 1:446 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-2012
Mailing Address - Country:US
Mailing Address - Phone:209-744-2136
Mailing Address - Fax:
Practice Address - Street 1:446 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2012
Practice Address - Country:US
Practice Address - Phone:209-744-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40221251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health