Healthcare Provider Details

I. General information

NPI: 1871681312
Provider Name (Legal Business Name): MICHELE MARIE HEYMAN MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE SUITE 103
RIO RANCHO NM
87124-1039
US

IV. Provider business mailing address

7719 LEAH DR NE
ALBUQUERQUE NM
87110-4826
US

V. Phone/Fax

Practice location:
  • Phone: 505-891-1583
  • Fax:
Mailing address:
  • Phone: 505-410-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0079921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: