Provider Demographics
NPI:1255174173
Name:HORST, KATE G
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:G
Last Name:HORST
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 1:142 ALDEN LN
Mailing Address - Street 2:
Mailing Address - City:EAST LEROY
Mailing Address - State:MI
Mailing Address - Zip Code:49051-9778
Mailing Address - Country:US
Mailing Address - Phone:330-641-8051
Mailing Address - Fax:
Practice Address - Street 1:142 ALDEN LN
Practice Address - Street 2:
Practice Address - City:EAST LEROY
Practice Address - State:MI
Practice Address - Zip Code:49051-9778
Practice Address - Country:US
Practice Address - Phone:330-641-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11882393163WG0000X
MI16635487103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty