Provider Demographics
NPI:1639292303
Name:YORK, HEIDI CLARICE (LPC)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:CLARICE
Last Name:YORK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2428
Mailing Address - Country:US
Mailing Address - Phone:719-542-3213
Mailing Address - Fax:
Practice Address - Street 1:27 W CIMARRON ST # 4
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3938
Practice Address - Country:US
Practice Address - Phone:719-248-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3410101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11809672OtherCAQH