Provider Demographics
NPI:1700341914
Name:SOMERS, HEIDI CHRISTINE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:CHRISTINE
Last Name:SOMERS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14865
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-4865
Mailing Address - Country:US
Mailing Address - Phone:307-413-4334
Mailing Address - Fax:
Practice Address - Street 1:330 N GLENWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8765
Practice Address - Country:US
Practice Address - Phone:307-413-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY214106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist