Basic Information
| Provider Information | |||||||||
| NPI: | 1679185714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORTON | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | RADT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 SUNRISE AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956614553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167823737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1530 3RD ST STE 111 | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956482501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168840015 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2020 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | R1399610720 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.