Provider Demographics
NPI:1982084786
Name:HEINRICHS, LESLIE (MED, BCBA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:HEINRICHS
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 JESSE LN
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-8068
Mailing Address - Country:US
Mailing Address - Phone:303-999-7799
Mailing Address - Fax:
Practice Address - Street 1:1552 JESSE LN
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-8068
Practice Address - Country:US
Practice Address - Phone:303-999-7799
Practice Address - Fax:844-432-5006
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-15264103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst