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General NPI Number Information
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NPI Number | 1619798246
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Entity Type | Individual
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Provider Name | AMMIEL RENAE HEIM LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 333 E ROOSEVELT ST APT 103
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City | PHOENIX
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State | AZ
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Zip | 85004-1943
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Country | US
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Telephone | 580-763-0392
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Fax |
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Provider Business Mailing Address
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Address Line | 333 E ROOSEVELT ST APT 103
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City | PHOENIX
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State | AZ
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Zip | 85004-1943
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Country | US
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Telephone | 580-763-0392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1361275
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 20461
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22593
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License Number State | AZ
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