1760710818 NPI number — SSUSAN ELIZABETH HORN

Table of content: (NPI 1760710818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760710818 NPI number — SSUSAN ELIZABETH HORN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSUSAN ELIZABETH HORN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760710818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 27TH ST
Provider Second Line Business Mailing Address:
SUITE 145
Provider Business Mailing Address City Name:
GLENWOOD SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81601-4194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-947-9497
Provider Business Mailing Address Fax Number:
907-947-9497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 27TH ST
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
GLENWOOD SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81601-4194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-947-9497
Provider Business Practice Location Address Fax Number:
907-947-9497
Provider Enumeration Date:
12/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HORN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
970-947-9497

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  991367 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 991367 . This is a "STATE LICENSE,LCSW" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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