Provider Demographics
NPI:1528798006
Name:HORTON, JANTELLE R (LSSP)
Entity type:Individual
Prefix:
First Name:JANTELLE
Middle Name:R
Last Name:HORTON
Suffix:
Gender:F
Credentials:LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9417 S MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3647
Mailing Address - Country:US
Mailing Address - Phone:773-710-8928
Mailing Address - Fax:
Practice Address - Street 1:9417 S MAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3647
Practice Address - Country:US
Practice Address - Phone:773-710-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist