Healthcare Provider Details

I. General information

NPI: 1134931868
Provider Name (Legal Business Name): CHRISTOPHER CLINTON HORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 4TH ST NW
ALBUQUERQUE NM
87102-1415
US

IV. Provider business mailing address

PO BOX 27258
ALBUQUERQUE NM
87125-7258
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax:
Mailing address:
  • Phone: 505-764-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: