Provider Demographics
NPI:1487926044
Name:HORN, JEREMY THOMAS (LPCC)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:THOMAS
Last Name:HORN
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SCARLETS WAY
Mailing Address - Street 2:
Mailing Address - City:BRONSTON
Mailing Address - State:KY
Mailing Address - Zip Code:42518-9611
Mailing Address - Country:US
Mailing Address - Phone:606-341-0277
Mailing Address - Fax:
Practice Address - Street 1:102 BOURNE AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-2102
Practice Address - Country:US
Practice Address - Phone:606-341-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00222202101YP2500X
LA4938101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional