Healthcare Provider Details

I. General information

NPI: 1588110274
Provider Name (Legal Business Name): PSYCHHORIZONS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E HORSETOOTH RD BUILDING 3, SUITE 201
FORT COLLINS CO
80525-3155
US

IV. Provider business mailing address

375 E HORSETOOTH RD BUILDING 3, SUITE 201
FORT COLLINS CO
80525-3155
US

V. Phone/Fax

Practice location:
  • Phone: 970-223-0356
  • Fax: 970-204-9767
Mailing address:
  • Phone: 970-223-0356
  • Fax: 970-204-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0001564
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.00989175
License Number StateCO

VIII. Authorized Official

Name: MS. MARCIA MCCONNELL RANCH
Title or Position: PRESIDENT
Credential: L.C.S.W.
Phone: 970-223-0356