Basic Information
Provider Information | |||||||||
NPI: | 1487933586 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HORWITZ | ||||||||
FirstName: | JULIE | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2695 ROCKY MOUNTAIN AVE STE 150 | ||||||||
Address2: |   | ||||||||
City: | LOVELAND | ||||||||
State: | CO | ||||||||
PostalCode: | 805389071 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9706244034 | ||||||||
FaxNumber: | 9704904347 | ||||||||
Practice Location | |||||||||
Address1: | 1725 E BOULDER ST STE 101 | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 80909 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7193656300 | ||||||||
FaxNumber: | 7193656094 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2011 | ||||||||
LastUpdateDate: | 08/29/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 9379 | MA | N |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   | 103G00000X | 3626 | CO | Y |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   |
No ID Information.