Provider Demographics
NPI:1912243858
Name:THE DEEPER CONNECTIONS, LLC/DBA STACEY HORN
Entity Type:Organization
Organization Name:THE DEEPER CONNECTIONS, LLC/DBA STACEY HORN
Other - Org Name:STACEY HORN, LCSW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-440-1324
Mailing Address - Street 1:PO BOX 6042
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-6042
Mailing Address - Country:US
Mailing Address - Phone:970-440-9132
Mailing Address - Fax:970-328-7832
Practice Address - Street 1:137 MAIN ST UNIT O-201
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632
Practice Address - Country:US
Practice Address - Phone:970-440-9132
Practice Address - Fax:970-328-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-21
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38820773Medicaid
COCOA100171Medicare PIN