Provider Demographics
NPI:1033805106
Name:HERZLEVESQUE, MIGNON AMII (HYPNOTHERAPIST)
Entity Type:Individual
Prefix:
First Name:MIGNON
Middle Name:AMII
Last Name:HERZLEVESQUE
Suffix:
Gender:F
Credentials:HYPNOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2072 HIBBARD LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4607
Mailing Address - Country:US
Mailing Address - Phone:719-726-4002
Mailing Address - Fax:
Practice Address - Street 1:2072 HIBBARD LN
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4607
Practice Address - Country:US
Practice Address - Phone:719-726-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171400000XOther Service ProvidersHealth & Wellness Coach