MEDICARE: BEVERLY HEREDIA MA, NCC

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	NLC-12889	CO

General Provider Information

NPI Number	:	1689913584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY HEREDIA MA, NCC

Provider Business Mailing Address
First Line	:	9157 W MAPLEWOOD DR
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80123-3242
Country	:	US
Telephone Number	:	303-904-9799
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 SHEA CENTER DR
Second Line	:	SUITE 400
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-1537
Country	:	US
Telephone Number	:	720-515-3812
Fax Number	:

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

Provider Enumeration Date	:	02/12/2013
Last Update Date	:	02/12/2013

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