Individual provider Active NPI

Ivy Renee Horn

  • Professional Counselor
  • Southfield, MI
National Provider Identifier
1104338763
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
6401001847 Issued in MI
Practice address
29623 Northwestern Hwy Ste 5
Southfield, MI 48034-1076
Phone
(248) 514-7254
NPI assigned
Nov 3, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 6401001847 MI Primary

Addresses

Primary practice location

29623 Northwestern Hwy Ste 5
Southfield, MI 48034-1076

Mailing address

21650 W 11 Mile Rd Ste 107
Southfield, MI 48076-3715
Phone (248) 514-7254

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
6401001847MIMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
I. R. Horn & Associates LLC CurrentSince Mar 9, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1104338763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21650 W 11 MILE RD STE 107",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480763715",
            "telephone_number": "248-514-7254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29623 NORTHWESTERN HWY STE 5",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480341076",
            "telephone_number": "248-514-7254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HORN",
        "first_name": "IVY",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-03",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": "6401001847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.