Provider Demographics
NPI:1407604788
Name:HORSLEY, ERNEST MCKAY (CSUDC)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:MCKAY
Last Name:HORSLEY
Suffix:
Gender:M
Credentials:CSUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1053 W 1020 S
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5656
Mailing Address - Country:US
Mailing Address - Phone:801-810-1234
Mailing Address - Fax:
Practice Address - Street 1:1053 W 1020 S
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5656
Practice Address - Country:US
Practice Address - Phone:801-810-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13408430-6005101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)