Healthcare Provider Details

I. General information

NPI: 1558192849
Provider Name (Legal Business Name): DAVID JAMES VAN HORN LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 UPTOWN BLVD NE STE 305
ALBUQUERQUE NM
87110-4148
US

IV. Provider business mailing address

1802 ANDERSON PL SE
ALBUQUERQUE NM
87108-4503
US

V. Phone/Fax

Practice location:
  • Phone: 505-219-1125
  • Fax:
Mailing address:
  • Phone: 505-803-6729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2024-0750
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: