Provider Demographics
NPI:1386767200
Name:FEDOR, HEIDI JAYE (LPC, LMFT)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:JAYE
Last Name:FEDOR
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 THUNDER LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9446
Mailing Address - Country:US
Mailing Address - Phone:303-579-6673
Mailing Address - Fax:
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3343
Practice Address - Country:US
Practice Address - Phone:303-494-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO460106H00000X
CO1931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist