Provider Demographics
NPI:1114171550
Name:HEIM, NICOLE M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:HEIM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 E DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-6716
Mailing Address - Country:US
Mailing Address - Phone:480-212-3349
Mailing Address - Fax:480-464-6700
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-212-3349
Practice Address - Fax:480-464-6700
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP2500X101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional