Provider Demographics
NPI:1447342464
Name:HORTON, THERESA (PHD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38991 MORRIS CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:OK
Mailing Address - Zip Code:74940-7341
Mailing Address - Country:US
Mailing Address - Phone:918-839-0825
Mailing Address - Fax:918-647-4339
Practice Address - Street 1:1301 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5260
Practice Address - Country:US
Practice Address - Phone:918-839-0825
Practice Address - Fax:918-647-4339
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK937103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service