Provider Demographics
NPI:1336743152
Name:EDMUNDS, HEIDI (LPC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:EDMUNDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 LARIAT LOOP
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-7621
Mailing Address - Country:US
Mailing Address - Phone:307-575-0078
Mailing Address - Fax:
Practice Address - Street 1:5856 LARIAT LOOP
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-7621
Practice Address - Country:US
Practice Address - Phone:307-575-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3364101YM0800X
FLTPMC3346101YM0800X
WY966101YP2500X, 101YM0800X
COLPC.0019423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional