Healthcare Provider Details

I. General information

NPI: 1386307932
Provider Name (Legal Business Name): HEIDI M CLAPHAM MC, LPC, LISAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 E BROADWAY RD STE 31
TEMPE AZ
85282-1885
US

IV. Provider business mailing address

2131 E BROADWAY RD STE 31
TEMPE AZ
85282-1885
US

V. Phone/Fax

Practice location:
  • Phone: 480-491-4444
  • Fax:
Mailing address:
  • Phone: 480-491-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10465
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-11948
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: