Provider Demographics
NPI:1689913584
Name:HEREDIA, BEVERLY (MA, NCC)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9157 W MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3242
Mailing Address - Country:US
Mailing Address - Phone:303-904-9799
Mailing Address - Fax:
Practice Address - Street 1:1745 SHEA CENTER DR
Practice Address - Street 2:SUITE 400
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-1537
Practice Address - Country:US
Practice Address - Phone:720-515-3812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC-12889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health