Provider Demographics
NPI:1952083479
Name:TA SHANNE HORN LICENSED CLINICAL SOCIAL WORKER INC
Entity Type:Organization
Organization Name:TA SHANNE HORN LICENSED CLINICAL SOCIAL WORKER INC
Other - Org Name:DYNAMIC HEARTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TA'SHANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:530-815-4328
Mailing Address - Street 1:PO BOX 8959
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-8959
Mailing Address - Country:US
Mailing Address - Phone:530-815-4328
Mailing Address - Fax:530-636-4772
Practice Address - Street 1:572 RIO LINDO AVE STE 203
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1851
Practice Address - Country:US
Practice Address - Phone:520-815-4328
Practice Address - Fax:530-636-4772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty