1578061628 NPI number — NICOLE J MCDOWELL-HORN LMHC, LPC-A

Table of content: NICOLE J MCDOWELL-HORN LMHC, LPC-A (NPI 1578061628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578061628 NPI number — NICOLE J MCDOWELL-HORN LMHC, LPC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDOWELL-HORN
Provider First Name:
NICOLE
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LPC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STANFORD
Provider Other First Name:
NICOLE
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578061628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 S AVENUE F APT 304
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXICO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88135-9663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-309-1286
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 S AVENUE F APT 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXICO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88135-9663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-309-1286
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  97385 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: CTB-2023-0742 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3293011 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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