Healthcare Provider Details

I. General information

NPI: 1265365878
Provider Name (Legal Business Name): GRACE HORNER TLMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MONTGOMERY ST
DECORAH IA
52101-2325
US

IV. Provider business mailing address

307 E REED ST APT 2
RED OAK IA
51566-4300
US

V. Phone/Fax

Practice location:
  • Phone: 563-382-3649
  • Fax:
Mailing address:
  • Phone: 402-669-4696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133208
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: