Provider Demographics
NPI:1205000700
Name:PHILLIPS, HEATHER A (LPC, CAC III)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 ASH HOPPER LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6215
Mailing Address - Country:US
Mailing Address - Phone:509-993-6245
Mailing Address - Fax:
Practice Address - Street 1:3335 ASH HOPPER LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6215
Practice Address - Country:US
Practice Address - Phone:509-993-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011811101YP2500X
COACC.0020790101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)