Basic Information
| Provider Information | |||||||||
| NPI: | 1467502476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRISH | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | NCC, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4851 INDEPENDENCE ST | ||||||||
| Address2: | |||||||||
| City: | WHEAT RIDGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800336715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034250300 | ||||||||
| FaxNumber: | 3034325071 | ||||||||
| Practice Location | |||||||||
| Address1: | 9485 W COLFAX AVE | ||||||||
| Address2: | JEFFERSON CENTER FOR MENTAL HEALTH | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802153918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325265 | ||||||||
| FaxNumber: | 3034325260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | NCC #201141 | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 3996 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.