Provider Demographics
NPI:1801971791
Name:HORLOCK, BRENT A (MS, LCPC)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:A
Last Name:HORLOCK
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3023
Mailing Address - Country:US
Mailing Address - Phone:630-761-0973
Mailing Address - Fax:
Practice Address - Street 1:2050 LARKIN AVE
Practice Address - Street 2:STE. 202
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4405
Practice Address - Country:US
Practice Address - Phone:847-697-2400
Practice Address - Fax:847-697-2438
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003217101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health