Provider Demographics
NPI:1962484170
Name:HORAN, EDWARD J (MS NCC LPC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:HORAN
Suffix:
Gender:M
Credentials:MS NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1757 CREEK VISTA DR
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2213
Mailing Address - Country:US
Mailing Address - Phone:717-525-1906
Mailing Address - Fax:
Practice Address - Street 1:5006 LENKER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-2440
Practice Address - Country:US
Practice Address - Phone:717-730-0733
Practice Address - Fax:717-730-0696
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001648101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50018305OtherHIGHMARK BLUE SHIELD