Provider Demographics
NPI:1659636355
Name:HADEN, HEIDI JOY (LPC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOY
Last Name:HADEN
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 1:20987 N JOHN WAYNE PKWY
Mailing Address - Street 2:B104-353
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2926
Mailing Address - Country:US
Mailing Address - Phone:520-709-1777
Mailing Address - Fax:
Practice Address - Street 1:19395 N JOHN WAYNE PKWY
Practice Address - Street 2:STE 4
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2833
Practice Address - Country:US
Practice Address - Phone:520-709-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional