Provider Demographics
NPI:1760753834
Name:HEDDEN, MICHAEL R (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:HEDDEN
Suffix:
Gender:M
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:P.O. BOX 8477
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85066
Mailing Address - Country:US
Mailing Address - Phone:602-635-0885
Mailing Address - Fax:
Practice Address - Street 1:8428 S. 16 DRIVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041
Practice Address - Country:US
Practice Address - Phone:602-635-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7794101YM0800X
AZLPC12686101YP2500X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional