Individual
HALEY LUCILLE WIEDENMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCC
Contact information
Practice address
2707 NEW MEXICO AVE, DURANGO, CO 81301-4722
(720) 480-0710
Mailing address
2707 NEW MEXICO AVE, DURANGO, CO 81301-4722
(720) 480-0710
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC.0019616
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018612
—
CO
Enumeration date
11/05/2021
Last updated
09/08/2023
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