=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770497331
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIGHORN BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 564 SPRUCE CIR
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-307-5035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 564 SPRUCE CIR
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-2703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-307-5035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | JUSTIN LEE HORNING
-----------------------------------------------------
Credential | LAC, LSW
-----------------------------------------------------
Telephone | 949-307-5035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------