Provider Demographics
NPI:1992572341
Name:HORNE, NICOLE ALIESE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ALIESE
Last Name:HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 E 45TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1091
Mailing Address - Country:US
Mailing Address - Phone:216-417-1115
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 320
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1091
Practice Address - Country:US
Practice Address - Phone:216-417-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty