Provider Demographics
NPI:1437344256
Name:HORNER, STEPHANIE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:HORNER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1241
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-1241
Mailing Address - Country:US
Mailing Address - Phone:575-209-1769
Mailing Address - Fax:575-756-1560
Practice Address - Street 1:16306 HWY 64/84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-9705
Practice Address - Country:US
Practice Address - Phone:575-209-1769
Practice Address - Fax:575-756-1560
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66931339Medicaid