Provider Demographics
NPI:1235918574
Name:WILSON, HEIDI KAY BAUMGARTNER (LCPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KAY BAUMGARTNER
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13 TWO BUMPS RD
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9219
Mailing Address - Country:US
Mailing Address - Phone:720-878-3676
Mailing Address - Fax:
Practice Address - Street 1:222 E MAIN ST STE 2C
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9230
Practice Address - Country:US
Practice Address - Phone:406-763-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-64793101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health