Healthcare Provider Details

I. General information

NPI: 1578061628
Provider Name (Legal Business Name): NICOLE J MCDOWELL-HORN LMHC, LPC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE JUNE STANFORD

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 STATE ROAD 522 STE 6
EL PRADO NM
87529-6051
US

IV. Provider business mailing address

520 CONRAD LN
TAOS NM
87571-6812
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-8903
  • Fax:
Mailing address:
  • Phone: 575-770-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97385
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0742
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: