Provider Demographics
NPI:1982944559
Name:HORTON, KRYSTAL STARR (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:STARR
Last Name:HORTON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HINEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-876-4010
Mailing Address - Fax:912-369-2262
Practice Address - Street 1:101 EAST MEMORIAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HINEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-876-4010
Practice Address - Fax:912-369-2262
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional