MEDICARE: HEIDI COLONY LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	301281	KY

General Provider Information

NPI Number	:	1649140898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI COLONY LPCA

Provider Business Mailing Address
First Line	:	1910 GARDEN SPRINGS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3665
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 GARDEN SPRINGS DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3665
Country	:	US
Telephone Number	:	859-493-8255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2025
Last Update Date	:	11/11/2025

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Directions to “ HEIDI COLONY LPCA” Practice Location

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