Healthcare Provider Details

I. General information

NPI: 1467370155
Provider Name (Legal Business Name): LISA KAY HORLACHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 S 10TH ST
TUCUMCARI NM
88401-3738
US

IV. Provider business mailing address

1902 S 10TH ST
TUCUMCARI NM
88401-3738
US

V. Phone/Fax

Practice location:
  • Phone: 804-931-7491
  • Fax:
Mailing address:
  • Phone: 804-931-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number100908140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: