Provider Demographics
NPI:1093958340
Name:MENZIE, HEATHER BROOKE (MA, LCPI)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:MENZIE
Suffix:
Gender:F
Credentials:MA, LCPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2201
Mailing Address - Street 2:OPEN SKY WILDERNESS THERAPY
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302
Mailing Address - Country:US
Mailing Address - Phone:970-382-8181
Mailing Address - Fax:970-382-9494
Practice Address - Street 1:466 SOUTH SKY LANE DR.
Practice Address - Street 2:OPEN SKY WILDERNESS THERAPY
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81302
Practice Address - Country:US
Practice Address - Phone:970-382-8181
Practice Address - Fax:970-382-9494
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7102936-60091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical