Provider Demographics
NPI:1124394291
Name:BODE, HEIDI (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:BODE
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 1:851 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421-2068
Mailing Address - Country:US
Mailing Address - Phone:303-229-6692
Mailing Address - Fax:
Practice Address - Street 1:851 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-2068
Practice Address - Country:US
Practice Address - Phone:303-229-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6255101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional