Provider Demographics
NPI:1619798246
Name:HEIM, AMMIEL RENAE (LCSW)
Entity type:Individual
Prefix:
First Name:AMMIEL
Middle Name:RENAE
Last Name:HEIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E ROOSEVELT ST APT 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1943
Mailing Address - Country:US
Mailing Address - Phone:580-763-0392
Mailing Address - Fax:
Practice Address - Street 1:333 E ROOSEVELT ST APT 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1943
Practice Address - Country:US
Practice Address - Phone:580-763-0392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID13612751041C0700X
OK204611041C0700X
AZ225931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical