Provider Demographics
NPI:1851310932
Name:QUINLAN, HEIDI JO (LPC,LIAC, LPCC, LADC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:QUINLAN
Suffix:
Gender:F
Credentials:LPC,LIAC, LPCC, LADC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:KOOPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 N NEEDLES DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:SD
Mailing Address - Zip Code:57005-1505
Mailing Address - Country:US
Mailing Address - Phone:480-229-9167
Mailing Address - Fax:
Practice Address - Street 1:105 N NEEDLES DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-1505
Practice Address - Country:US
Practice Address - Phone:480-229-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4905101YM0800X
SDLPC21094101YM0800X
AZLIAC-11071101YM0800X
AZLPC-13084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ298896Medicaid