Provider Demographics
NPI:1538221205
Name:HORAN, MARK J (LCMHC, LCPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:HORAN
Suffix:
Gender:M
Credentials:LCMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2726
Mailing Address - Street 2:81 WASHINGTON ST.
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-2726
Mailing Address - Country:US
Mailing Address - Phone:603-447-2453
Mailing Address - Fax:603-447-2450
Practice Address - Street 1:81 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6044
Practice Address - Country:US
Practice Address - Phone:603-447-2453
Practice Address - Fax:603-447-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH315101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424635Medicaid