Provider Demographics
NPI:1689107864
Name:VAN HORNE, JACQUIE INELL
Entity Type:Individual
Prefix:
First Name:JACQUIE
Middle Name:INELL
Last Name:VAN HORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUALYN
Other - Middle Name:INELL
Other - Last Name:VAN HORNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC, R-DMT
Mailing Address - Street 1:8005 MONTVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4204
Mailing Address - Country:US
Mailing Address - Phone:970-633-0356
Mailing Address - Fax:
Practice Address - Street 1:1355 S COLORADO BLVD
Practice Address - Street 2:SUITE C-100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-3305
Practice Address - Country:US
Practice Address - Phone:303-756-9052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0105283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health