Provider Demographics
NPI:1710685706
Name:HEBERT, NAN E (MA, PHD(C), LPCC)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:E
Last Name:HEBERT
Suffix:
Gender:F
Credentials:MA, PHD(C), LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4218
Mailing Address - Country:US
Mailing Address - Phone:917-723-4449
Mailing Address - Fax:
Practice Address - Street 1:1630 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4218
Practice Address - Country:US
Practice Address - Phone:917-723-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0018948103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling