Provider Demographics
NPI:1831258003
Name:MORTENSON, HEIDI LYNN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:MORTENSON
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 1:21000 ROGERS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4652
Mailing Address - Country:US
Mailing Address - Phone:763-291-5505
Mailing Address - Fax:763-657-0819
Practice Address - Street 1:21000 ROGERS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4652
Practice Address - Country:US
Practice Address - Phone:763-291-5505
Practice Address - Fax:763-657-0819
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X
MN1894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health