Provider Demographics
NPI:1366779688
Name:HORRELL, NICOLE LEANNE (PLCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEANNE
Last Name:HORRELL
Suffix:
Gender:F
Credentials:PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 OLD CAPE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3725
Mailing Address - Country:US
Mailing Address - Phone:573-204-8901
Mailing Address - Fax:
Practice Address - Street 1:3191 OLD CAPE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3725
Practice Address - Country:US
Practice Address - Phone:573-204-8901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090337551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical