Provider Demographics
NPI:1205965993
Name:HORTON, WILLIAM CHARLES (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:HORTON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 N OLD WOODWARD AVE
Mailing Address - Street 2:STE. 156
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5347
Mailing Address - Country:US
Mailing Address - Phone:248-377-9428
Mailing Address - Fax:
Practice Address - Street 1:380 N OLD WOODWARD AVE
Practice Address - Street 2:STE. 156
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5347
Practice Address - Country:US
Practice Address - Phone:248-377-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006621103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000F32353OtherBLUE CROSS BLUE SHIELD
MI0N47790Medicare PIN