Provider Demographics
NPI:1225569064
Name:PERRY, HEIDI ANNE (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANNE
Last Name:PERRY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CORPORATE DR.
Mailing Address - Street 2:SUITE 105 YOUTH DYNAMICS
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-751-8017
Mailing Address - Fax:406-751-1139
Practice Address - Street 1:205 NORTHWEST LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3059
Practice Address - Country:US
Practice Address - Phone:406-756-3950
Practice Address - Fax:406-756-3957
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MTBBH-LCPC-LIC-23437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health