Provider Demographics
NPI:1588110274
Name:PSYCHHORIZONS, P.C.
Entity type:Organization
Organization Name:PSYCHHORIZONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNELL RANCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-223-0356
Mailing Address - Street 1:375 E HORSETOOTH RD
Mailing Address - Street 2:BUILDING 3, SUITE 201
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3155
Mailing Address - Country:US
Mailing Address - Phone:970-223-0356
Mailing Address - Fax:970-204-9767
Practice Address - Street 1:375 E HORSETOOTH RD
Practice Address - Street 2:BUILDING 3, SUITE 201
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3155
Practice Address - Country:US
Practice Address - Phone:970-223-0356
Practice Address - Fax:970-204-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.009891751041C0700X
COPSY.0001564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO636881Medicaid