Provider Demographics
NPI:1629244934
Name:HORNING RIEDER, ALICE SUZANNE (MA DTR LPC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:SUZANNE
Last Name:HORNING RIEDER
Suffix:
Gender:F
Credentials:MA DTR LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-1634
Mailing Address - Country:US
Mailing Address - Phone:970-234-4863
Mailing Address - Fax:970-399-7109
Practice Address - Street 1:341 W. BRIDGE ST.
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419-9999
Practice Address - Country:US
Practice Address - Phone:970-399-7084
Practice Address - Fax:970-399-7109
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2000-DTR-1207225600000X
CO3324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO841439569004OtherROCKY MOUNTAIN HEALTH PLANS
CO624322Medicaid