Provider Demographics
NPI:1891049631
Name:KREBS-HERITAGE, CYNTHIA (MA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KREBS-HERITAGE
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 1:731 N WEBER ST
Mailing Address - Street 2:SUITE 245
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1049
Mailing Address - Country:US
Mailing Address - Phone:719-231-4962
Mailing Address - Fax:
Practice Address - Street 1:731 N WEBER ST
Practice Address - Street 2:SUITE 245
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-231-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10948101YM0800X
CO0011291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health