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Provider Information for 1396314449


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Ms. BERNELL HORNSBY M.A., L.P.C.


Sex: Female

NPI: 1396314449
Last Updated: 2022-07-05
Certification Date: 2022-07-05

Details

NameValue
NPI1396314449
Enumeration Date2021-06-23
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 9466 NAVAJO TRL APT 11
MORONGO VALLEY, CA 92256-9823
United States

Phone: 612-227-9382 | Fax:
 
Primary Practice Address 9466 NAVAJO TRL APT 11
MORONGO VALLEY, CA 92256-9823
United States

Phone: 612-227-9382 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 193400000X - Single Specialty Group
101YM0800X - Counselor - Mental Health
MI6401002145