MEDICARE: IAN PATRICK HEINLE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZGP831996400	OTHER	TX	BCBS TEXAS

General Provider Information

NPI Number	:	1689245912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN PATRICK HEINLE

Provider Business Mailing Address
First Line	:	1776 S CORONA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3238
Country	:	US
Telephone Number	:	703-509-9252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1776 S CORONA ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-3238
Country	:	US
Telephone Number	:	703-509-9252
Fax Number	:

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	07/07/2021

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Directions to “ IAN PATRICK HEINLE ” Practice Location

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