Provider Demographics
NPI:1386246353
Name:HORN, DOROTHY R (LMSW, LMAC)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:R
Last Name:HORN
Suffix:
Gender:F
Credentials:LMSW, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 E AMITY ST
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-4076
Mailing Address - Country:US
Mailing Address - Phone:913-837-4653
Mailing Address - Fax:913-837-4776
Practice Address - Street 1:105 E AMITY ST
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-4076
Practice Address - Country:US
Practice Address - Phone:913-837-4653
Practice Address - Fax:913-837-4776
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11037104100000X
KS827101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS827OtherPRIVATE INSURANCE
KS11037OtherPRIVATE INSURANCE