Provider Demographics
NPI:1972966745
Name:HORTON, MATTIE (LPC, LICDC-CS)
Entity Type:Individual
Prefix:MRS
First Name:MATTIE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:LPC, LICDC-CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 VERNON PL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2417
Mailing Address - Country:US
Mailing Address - Phone:513-541-7099
Mailing Address - Fax:513-541-0989
Practice Address - Street 1:3021 VERNON PL
Practice Address - Street 2:SUITE 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2417
Practice Address - Country:US
Practice Address - Phone:513-541-7099
Practice Address - Fax:513-541-0989
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101078101Y00000X, 101YA0400X
OHLICDC.101078101YA0400X
OH0004490101YP2500X
OHC.0004490101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional