Healthcare Provider Details

I. General information

NPI: 1689112013
Provider Name (Legal Business Name): SHELLY HEINRICHS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13123 E 16TH AVE
AURORA CO
80045-7106
US

IV. Provider business mailing address

13123 E 16TH AVE
AURORA CO
80045-7106
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-5133
  • Fax: 720-777-7283
Mailing address:
  • Phone: 720-777-5133
  • Fax: 720-777-7283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW.09924096
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number50904
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: