Provider Demographics
NPI:1124462858
Name:HORTON, MARYELLEN
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:HORTON
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:PO BOX 907
Mailing Address - Street 2:UNION COUNTY SCHOOLS
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-0907
Mailing Address - Country:US
Mailing Address - Phone:864-429-1735
Mailing Address - Fax:864-429-2828
Practice Address - Street 1:120 LAKESIDE DR
Practice Address - Street 2:UNION COUNTY SCHOOLS
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-1939
Practice Address - Country:US
Practice Address - Phone:864-429-1735
Practice Address - Fax:864-429-2828
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool