Provider Demographics
NPI:1770914079
Name:HORVATH, KELLEY
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:
Last Name:HORVATH
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 1:675 OAKLAWN CIR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2930
Mailing Address - Country:US
Mailing Address - Phone:606-215-6818
Mailing Address - Fax:606-261-7539
Practice Address - Street 1:675 OAKLAWN CIR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2930
Practice Address - Country:US
Practice Address - Phone:606-215-6818
Practice Address - Fax:606-261-7539
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103K00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst