Healthcare Provider Details

I. General information

NPI: 1871214387
Provider Name (Legal Business Name): ANGELA LEE HEYEN ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MAIN ST STE 201
ST CHARLES IL
60174-2287
US

IV. Provider business mailing address

1120 E MAIN ST STE 201
ST CHARLES IL
60174-2287
US

V. Phone/Fax

Practice location:
  • Phone: 630-377-6613
  • Fax: 630-377-6225
Mailing address:
  • Phone: 630-377-6613
  • Fax: 630-377-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number208001006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: