Provider Demographics
NPI:1467698928
Name:HERON, IMA JEAN (LPCC)
Entity type:Individual
Prefix:
First Name:IMA
Middle Name:JEAN
Last Name:HERON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32669 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:THOUSAND PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92276-3605
Mailing Address - Country:US
Mailing Address - Phone:719-232-4589
Mailing Address - Fax:
Practice Address - Street 1:32669 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:THOUSAND PALMS
Practice Address - State:CA
Practice Address - Zip Code:92276-3605
Practice Address - Country:US
Practice Address - Phone:719-232-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4477101YM0800X
CA16883101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health