Provider Demographics
NPI:1962262964
Name:HORN, GRADY C (LCSW)
Entity type:Individual
Prefix:MR
First Name:GRADY
Middle Name:C
Last Name:HORN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WILDWOOD DR STE 105
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-1344
Mailing Address - Country:US
Mailing Address - Phone:512-763-4060
Mailing Address - Fax:512-763-4088
Practice Address - Street 1:105 WILDWOOD DR STE 105
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-1344
Practice Address - Country:US
Practice Address - Phone:512-763-4060
Practice Address - Fax:512-763-4088
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX668761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical