Provider Demographics
NPI:1023774643
Name:KOHLHASE, HEATHER ANN (MFTC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:KOHLHASE
Suffix:
Gender:F
Credentials:MFTC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:KOHLHASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19474 RIM OF THE WORLD DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-9435
Mailing Address - Country:US
Mailing Address - Phone:719-473-1024
Mailing Address - Fax:
Practice Address - Street 1:6180 LEHMAN DR STE 211
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3459
Practice Address - Country:US
Practice Address - Phone:719-357-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0014162106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist