Provider Demographics
NPI:1619998986
Name:DR. HORGAN & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DR. HORGAN & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:719-337-3186
Mailing Address - Street 1:745 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2711
Mailing Address - Country:US
Mailing Address - Phone:719-337-3186
Mailing Address - Fax:719-272-6464
Practice Address - Street 1:745 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2711
Practice Address - Country:US
Practice Address - Phone:719-337-3186
Practice Address - Fax:719-272-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70020230Medicaid
COC537308Medicare ID - Type UnspecifiedMARY J. HORGAN
CO70020230Medicaid