Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
Y | 103G00000X | Clinical Psychologist | 20041741A | IN |
Y | 103TC0700X | Clinical Psychologist | 20041741A | IN |
N | 103TM1800X | Intellectual & Developmental Disabilities |
NPI | 1376827915 |
---|---|
Provider Name | Mr. Boyd Randal Horton |
First Address | Indianapolis, IN 46234-8903 |
Second Address | Indianapolis, IN 46202-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2011 |
Last Update Date | 26/06/2019 |