Provider Demographics
NPI:1841872082
Name:HORIZON PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:HORIZON PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR AND PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DUNEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCPS
Authorized Official - Phone:219-916-0822
Mailing Address - Street 1:3522 N PINE GROVE AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7381
Mailing Address - Country:US
Mailing Address - Phone:219-916-0822
Mailing Address - Fax:
Practice Address - Street 1:3354 N PAULINA ST STE 206F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1087
Practice Address - Country:US
Practice Address - Phone:219-916-0822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty