Healthcare Provider Details

I. General information

NPI: 1417186669
Provider Name (Legal Business Name): JOAN ADELE HEIDEN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5686 AGUA FRIA ST
SANTA FE NM
87507-9001
US

IV. Provider business mailing address

5686 AGUA FRIA P.O. BOX 28279
SANTA FE NM
87592
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-0586
  • Fax:
Mailing address:
  • Phone: 505-983-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: