Provider Demographics
NPI:1700406287
Name:VAN HORN, TRUDIE SHARLENE (PLMHP)
Entity Type:Individual
Prefix:
First Name:TRUDIE
Middle Name:SHARLENE
Last Name:VAN HORN
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:TRUDIE
Other - Middle Name:SHARLENE
Other - Last Name:GARWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 W NORFOLK AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5221
Mailing Address - Country:US
Mailing Address - Phone:402-379-2030
Mailing Address - Fax:
Practice Address - Street 1:333 W NORFOLK AVE STE 201
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5221
Practice Address - Country:US
Practice Address - Phone:402-379-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39189435426Medicaid