=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053199190
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALLORY HORNING MSW, MPH, CSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 S COLLEGE AVE STE 200
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-810-2355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2451 S TIMBERLINE RD APT 6-104
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-4165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-653-5282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SWC.0000001555
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------