Healthcare Provider Details

I. General information

NPI: 1134964034
Provider Name (Legal Business Name): JUSTIN HORNING LSW, LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 SPRUCE CIR
LOUISVILLE CO
80027-2703
US

IV. Provider business mailing address

564 SPRUCE CIR
LOUISVILLE CO
80027-2703
US

V. Phone/Fax

Practice location:
  • Phone: 928-487-0757
  • Fax:
Mailing address:
  • Phone: 928-487-0757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA.0008553
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACD.0003057
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009927751
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: