Healthcare Provider Details

I. General information

NPI: 1912289448
Provider Name (Legal Business Name): HEATHER MATHENY B.C.B.A, ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2011
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 N ARCADIA ST
COLORADO SPRINGS CO
80903-2639
US

IV. Provider business mailing address

1118 N ARCADIA ST
COLORADO SPRINGS CO
80903-2639
US

V. Phone/Fax

Practice location:
  • Phone: 720-384-5312
  • Fax:
Mailing address:
  • Phone: 720-384-5312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8937
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: