Provider Demographics
NPI:1750675666
Name:HAFENSTINE, HEIDI (MA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HAFENSTINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 COLORADO BLVD
Mailing Address - Street 2:APT 404
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3659
Mailing Address - Country:US
Mailing Address - Phone:303-552-8413
Mailing Address - Fax:
Practice Address - Street 1:190 E 9TH AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2736
Practice Address - Country:US
Practice Address - Phone:720-336-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11975101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor