Provider Demographics
NPI:1245508472
Name:HORSLEY, MICHELE R (MA)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:R
Last Name:HORSLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1437
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-1437
Mailing Address - Country:US
Mailing Address - Phone:505-863-3377
Mailing Address - Fax:505-722-5622
Practice Address - Street 1:102 E AZTEC AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6256
Practice Address - Country:US
Practice Address - Phone:505-863-3377
Practice Address - Fax:505-722-5622
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0144861101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health