Provider Demographics
NPI:1780140384
Name:GOMEZ, HEATHER (MA, LMFT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 W 6TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1880
Mailing Address - Country:US
Mailing Address - Phone:303-578-0861
Mailing Address - Fax:
Practice Address - Street 1:2095 W 6TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-1880
Practice Address - Country:US
Practice Address - Phone:303-578-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist