Provider Demographics
NPI:1033437025
Name:T.HORN ENTERPRISES, INC,
Entity Type:Organization
Organization Name:T.HORN ENTERPRISES, INC,
Other - Org Name:DBA FAMILY ROOM CO.,STACEY HORN, LCSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA
Authorized Official - Phone:970-616-4401
Mailing Address - Street 1:PO BOX 6042
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-6042
Mailing Address - Country:US
Mailing Address - Phone:970-616-4401
Mailing Address - Fax:970-616-4401
Practice Address - Street 1:407 BROADWAY
Practice Address - Street 2:#2
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-6042
Practice Address - Country:US
Practice Address - Phone:970-616-4401
Practice Address - Fax:970-616-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38820773Medicaid
CO38820773Medicaid