Provider Demographics
NPI:1821763905
Name:KINNEY, HEATHER (LMHC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KINNEY
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DOC HOLIDAY CT
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:NM
Mailing Address - Zip Code:88312-9545
Mailing Address - Country:US
Mailing Address - Phone:702-340-5447
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR STE 3
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7067
Practice Address - Country:US
Practice Address - Phone:505-273-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCMH0225521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty