Basic Information
| Provider Information | |||||||||
| NPI: | 1194903831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORNSBY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4905 SOUTH 3200 WEST | ||||||||
| Address2: | |||||||||
| City: | TAYLORSVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018240616 | ||||||||
| FaxNumber: | 3096710503 | ||||||||
| Practice Location | |||||||||
| Address1: | 2319 S FOOTHILL DR STE 180 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841095403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018240616 | ||||||||
| FaxNumber: | 8889726493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 180006277 | IL | N | Behavioral Health & Social Service Providers | Counselor | 101YP1600X | IL | N | Behavioral Health & Social Service Providers | Counselor | Pastoral | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.