Provider Demographics
NPI:1164393419
Name:HORTON, AMANDA RAE I
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:RAE
Last Name:HORTON
Suffix:I
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 1:1424 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-4309
Mailing Address - Country:US
Mailing Address - Phone:517-312-1711
Mailing Address - Fax:517-313-1711
Practice Address - Street 1:111 N MCVICAR ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3056
Practice Address - Country:US
Practice Address - Phone:517-312-1711
Practice Address - Fax:517-313-1711
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH635066730822106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician