Provider Demographics
NPI:1750550398
Name:HORTON, BRUCE BERNARD (LAC)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:BERNARD
Last Name:HORTON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2803
Mailing Address - Country:US
Mailing Address - Phone:479-964-2011
Mailing Address - Fax:
Practice Address - Street 1:1 LILE CT STE 200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6240
Practice Address - Country:US
Practice Address - Phone:501-663-1837
Practice Address - Fax:501-663-1839
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
ARA2401011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator