Provider Demographics
NPI:1417186669
Name:HEIDEN, JOAN ADELE (LPCC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ADELE
Last Name:HEIDEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 AGUA FRIA
Mailing Address - Street 2:P.O. BOX 28279
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592
Mailing Address - Country:US
Mailing Address - Phone:505-983-0586
Mailing Address - Fax:
Practice Address - Street 1:5686 AGUA FRIA ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-9001
Practice Address - Country:US
Practice Address - Phone:505-983-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional