MEDICARE: IMA JEAN HERON LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	4477	MT
2	101YM0800X	Mental Health Counselor	16883	CA

General Provider Information

NPI Number	:	1467698928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMA JEAN HERON LPCC

Provider Business Mailing Address
First Line	:	32669 BLOOMFIELD AVE
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3605
Country	:	US
Telephone Number	:	719-232-4589
Fax Number	:

Provider Business Practice Location Address
First Line	:	32669 BLOOMFIELD AVE
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3605
Country	:	US
Telephone Number	:	719-232-4589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	05/22/2025

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