Provider Demographics
NPI:1801151097
Name:HORTON, MAURICE DEMARCO
Entity type:Individual
Prefix:MR
First Name:MAURICE
Middle Name:DEMARCO
Last Name:HORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15083 COUNTY ROAD 1450
Mailing Address - Street 2:
Mailing Address - City:APACHE
Mailing Address - State:OK
Mailing Address - Zip Code:73006-9717
Mailing Address - Country:US
Mailing Address - Phone:314-703-6013
Mailing Address - Fax:
Practice Address - Street 1:4411 W GORE BLVD
Practice Address - Street 2:STE B8
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-699-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health