Provider Demographics
NPI:1952374621
Name:HALL-HEYDUK, ROSEMARIE GERDA (LMFT, CAC III)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:GERDA
Last Name:HALL-HEYDUK
Suffix:
Gender:F
Credentials:LMFT, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 AUTUMN HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5909
Mailing Address - Country:US
Mailing Address - Phone:719-527-9196
Mailing Address - Fax:
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:DBH-ASAP
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-8414
Practice Address - Fax:719-526-0608
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5211101YA0400X
CO568106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist