Provider Demographics
NPI:1669831889
Name:HORROCKS, CARLIE MICHELLE
Entity type:Individual
Prefix:
First Name:CARLIE
Middle Name:MICHELLE
Last Name:HORROCKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4478
Mailing Address - Country:US
Mailing Address - Phone:208-233-1276
Mailing Address - Fax:208-233-0835
Practice Address - Street 1:1023 YELLOWSTONE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4478
Practice Address - Country:US
Practice Address - Phone:208-233-1276
Practice Address - Fax:208-233-0835
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID32449104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker