Healthcare Provider Details

I. General information

NPI: 1467502476
Provider Name (Legal Business Name): HEATHER MICHELLE TRISH NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 W COLFAX AVE JEFFERSON CENTER FOR MENTAL HEALTH
LAKEWOOD CO
80215-3918
US

IV. Provider business mailing address

4851 INDEPENDENCE ST
WHEAT RIDGE CO
80033-6715
US

V. Phone/Fax

Practice location:
  • Phone: 303-432-5265
  • Fax: 303-432-5260
Mailing address:
  • Phone: 303-425-0300
  • Fax: 303-432-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNCC #201141
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3996
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: