Provider Demographics
NPI:1538868088
Name:HOROSCHAK, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HOROSCHAK
Suffix:
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 1:1443 MILLERS CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1669
Mailing Address - Country:US
Mailing Address - Phone:330-441-9311
Mailing Address - Fax:
Practice Address - Street 1:6067 DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9606
Practice Address - Country:US
Practice Address - Phone:317-856-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician