Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 2371 | OR |
NPI | 1073905758 |
---|---|
Provider Name | Dr. Brent Horner |
First Address | Eugene, OR 97401-3154 |
Second Address | Eugene, OR 97401-3154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2015 |
Last Update Date | 30/05/2017 |