Basic Information
Provider Information | |||||||||
NPI: | 1952374621 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HALL-HEYDUK | ||||||||
FirstName: | ROSEMARIE | ||||||||
MiddleName: | GERDA | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMFT, CAC III | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4090 AUTUMN HEIGHTS DR | ||||||||
Address2: |   | ||||||||
City: | COLORADO SPRINGS | ||||||||
State: | CO | ||||||||
PostalCode: | 809065909 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195279196 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1650 COCHRANE CIR | ||||||||
Address2: | DBH-ASAP | ||||||||
City: | FT CARSON | ||||||||
State: | CO | ||||||||
PostalCode: | 809134603 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7195268414 | ||||||||
FaxNumber: | 7195260608 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/10/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 5211 | CO | X |   | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | 568 | CO | X |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.