Provider Demographics
NPI:1992246060
Name:HORNE, AMY (MSW, LSCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HORNE
Suffix:
Gender:F
Credentials:MSW, LSCSW
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:KISTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1113 S BRECKENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-3632
Mailing Address - Country:US
Mailing Address - Phone:571-748-9949
Mailing Address - Fax:
Practice Address - Street 1:1113 S BRECKENRIDGE CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-3632
Practice Address - Country:US
Practice Address - Phone:571-748-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS054111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical