Provider Demographics
NPI:1366629032
Name:METCALF, HEIDI JAN (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JAN
Last Name:METCALF
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 EDITH BLVD SE
Mailing Address - Street 2:STE. B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3528
Mailing Address - Country:US
Mailing Address - Phone:505-331-3838
Mailing Address - Fax:
Practice Address - Street 1:111 EDITH BLVD SE
Practice Address - Street 2:STE. B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3528
Practice Address - Country:US
Practice Address - Phone:505-331-3838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0099871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health