Provider Demographics
NPI:1497216105
Name:HEISTAND-PHELPS, ALLISON RENEE (LPCC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RENEE
Last Name:HEISTAND-PHELPS
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 1:4901 W 93RD AVE APT 223
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6320
Mailing Address - Country:US
Mailing Address - Phone:608-358-6235
Mailing Address - Fax:
Practice Address - Street 1:1501 YARMOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0564
Practice Address - Country:US
Practice Address - Phone:303-786-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0016328101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health