Provider Demographics
NPI:1063905214
Name:HEBERT, EMMIE ROSE (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:EMMIE
Middle Name:ROSE
Last Name:HEBERT
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 INVERNESS PKWY STE 375
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6083
Mailing Address - Country:US
Mailing Address - Phone:303-284-7328
Mailing Address - Fax:833-235-4105
Practice Address - Street 1:369 INVERNESS PKWY STE 375
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-6083
Practice Address - Country:US
Practice Address - Phone:303-284-7328
Practice Address - Fax:833-235-4105
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11515101YM0800X
1-19-38500103K00000X
COPSY.0005389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst