Provider Demographics
NPI:1811967581
Name:HORTON, PAMELA (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:PHD
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 1087
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-1087
Mailing Address - Country:US
Mailing Address - Phone:512-931-2162
Mailing Address - Fax:
Practice Address - Street 1:1618 WILLIAMS DR
Practice Address - Street 2:SUITE 6
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3660
Practice Address - Country:US
Practice Address - Phone:512-931-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009206L103TC0700X
TX2-5250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0360430-01Medicaid
PA080070ST0Medicare PIN
TX0360430-01Medicaid