Provider Demographics
NPI:1801392931
Name:HORNER, EVALIE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:EVALIE
Middle Name:
Last Name:HORNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 VALMONT RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1360
Mailing Address - Country:US
Mailing Address - Phone:323-557-7193
Mailing Address - Fax:
Practice Address - Street 1:2955 VALMONT RD STE 120
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1360
Practice Address - Country:US
Practice Address - Phone:323-557-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty