Provider Demographics
NPI:1710963137
Name:OVERALL-BLOCK, HEIDI MARIE (MA - LMFT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIE
Last Name:OVERALL-BLOCK
Suffix:
Gender:F
Credentials:MA - LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4618
Mailing Address - Country:US
Mailing Address - Phone:307-638-1228
Mailing Address - Fax:307-433-0991
Practice Address - Street 1:520 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4618
Practice Address - Country:US
Practice Address - Phone:307-638-1228
Practice Address - Fax:307-433-0991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY50106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY310037OtherBLUECROSS BLUE SHIELD