Basic Information
Provider Information | |||||||||
NPI: | 1437588043 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HORTON | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | JAY | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24337 RAMBLER RD | ||||||||
Address2: |   | ||||||||
City: | CHUGIAK | ||||||||
State: | AK | ||||||||
PostalCode: | 995675531 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9075126969 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1840 BRAGAW ST STE 110 | ||||||||
Address2: |   | ||||||||
City: | ANCHORAGE | ||||||||
State: | AK | ||||||||
PostalCode: | 995083463 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9073340143 | ||||||||
FaxNumber: | 9075632891 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/04/2013 | ||||||||
LastUpdateDate: | 02/17/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 11-044-BHP | AK | N |   | Behavioral Health & Social Service Providers | Counselor |   | 101YA0400X | 2886 | AK | N |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YP2500X | 616 | AK | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.