Provider Demographics
NPI:1578796017
Name:HORN, STACEY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:
Last Name:HORN
Suffix:
Gender:F
Credentials:LCSW
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 1302
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-1302
Mailing Address - Country:US
Mailing Address - Phone:615-450-1004
Mailing Address - Fax:
Practice Address - Street 1:207 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2919
Practice Address - Country:US
Practice Address - Phone:970-688-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2022-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW6391041C0700X
TN70971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO289374YR9SMedicare PIN
CO41184769Medicaid
COCOA100171Medicare PIN