Provider Demographics
NPI:1982639472
Name:VAN HORN, FIROZA B (PSY D)
Entity Type:Individual
Prefix:DR
First Name:FIROZA
Middle Name:B
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43902 WOODWARD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302
Mailing Address - Country:US
Mailing Address - Phone:248-858-8412
Mailing Address - Fax:248-858-8411
Practice Address - Street 1:43902 WOODWARD
Practice Address - Street 2:SUITE 230
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302
Practice Address - Country:US
Practice Address - Phone:248-858-8412
Practice Address - Fax:248-858-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007958103G00000X, 103TC0700X
MI103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680F335710OtherBLUE CROSS BLUE SHIELD
MIOP52020Medicare UPIN
MI680F335710OtherBLUE CROSS BLUE SHIELD