Provider Demographics
NPI:1548344831
Name:HORTON, SAMUEL A (MSW,LCSW, LMFT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:A
Last Name:HORTON
Suffix:
Gender:M
Credentials:MSW,LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19732 S HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDS
Mailing Address - State:OK
Mailing Address - Zip Code:74047-5014
Mailing Address - Country:US
Mailing Address - Phone:918-366-8146
Mailing Address - Fax:
Practice Address - Street 1:12 & 12 INC. CENTER FOR ADDICTION TREATMENT
Practice Address - Street 2:6333 E. SKELLY DRIVE
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-664-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK08141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical