Provider Demographics
NPI:1952451734
Name:JORGENSEN, HEIDI (MS, LMFT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MS, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 E COPPER POINT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9276
Mailing Address - Country:US
Mailing Address - Phone:208-376-5683
Mailing Address - Fax:208-376-5690
Practice Address - Street 1:2971 E COPPER POINT DR STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9276
Practice Address - Country:US
Practice Address - Phone:208-376-5683
Practice Address - Fax:208-376-5690
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-2653101YP2500X
IDLMFT-2868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional