Provider Demographics
NPI:1124036264
Name:HEYDEN, MICHELLE GONWA (MAAT, LCPC)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:GONWA
Last Name:HEYDEN
Suffix:
Gender:F
Credentials:MAAT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 W WELLINGTON AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7822
Mailing Address - Country:US
Mailing Address - Phone:312-213-2226
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 905
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:312-213-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.006189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health