Provider Demographics
NPI:1538540034
Name:HEAP, AMY (MA, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HEAP
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18570 COUNTY ROAD 162
Mailing Address - Street 2:
Mailing Address - City:NATHROP
Mailing Address - State:CO
Mailing Address - Zip Code:81236-7745
Mailing Address - Country:US
Mailing Address - Phone:719-398-0018
Mailing Address - Fax:
Practice Address - Street 1:36 OAK STREET
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81236
Practice Address - Country:US
Practice Address - Phone:719-398-0018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0006454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional