Provider Demographics
NPI:1467502476
Name:TRISH, HEATHER MICHELLE (NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:TRISH
Suffix:
Gender:F
Credentials:NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6715
Mailing Address - Country:US
Mailing Address - Phone:303-425-0300
Mailing Address - Fax:303-432-5071
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:JEFFERSON CENTER FOR MENTAL HEALTH
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:303-432-5265
Practice Address - Fax:303-432-5260
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC #201141101Y00000X
CO3996101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor