Healthcare Provider Details

I. General information

NPI: 1639993157
Provider Name (Legal Business Name): HEARTLAND WELLNESS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 W CEDAR DR STE 200
LAKEWOOD CO
80228-2105
US

IV. Provider business mailing address

1019 S ALKIRE ST
LAKEWOOD CO
80228-3111
US

V. Phone/Fax

Practice location:
  • Phone: 303-325-5617
  • Fax:
Mailing address:
  • Phone: 303-325-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SUJATHA REDDY
Title or Position: CEO
Credential: LPC
Phone: 303-325-5617