Individual provider Active NPI

Heather T Whittall, PSYD

  • Psychologist
  • Boulder, CO
National Provider Identifier
1154637189
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
3829 Issued in CO
Practice address
1800 30TH St Ste 212
Boulder, CO 80301-1087
Phone
(720) 591-4664
NPI assigned
Aug 27, 2010
Last updated
Dec 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 3829 CO
Psychologist 103T00000X 3829 CO Primary

Addresses

Primary practice location

1800 30TH St Ste 212
Boulder, CO 80301-1087

Mailing address

1800 30TH St Ste 212
Boulder, CO 80301-1087
Phone (720) 591-4664

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 1, 2025 through Apr 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3829COMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Valley Psychotherapy Inc. Psychologist CurrentSince Oct 1, 2023 Accepting new patients

Locations

1800 30th St
Ste 212
Boulder, CO 80301
Phone (720) 340-3441

400 E Simpson St
Ste 104
Lafayette, CO 80026
Phone (720) 722-1339

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1154637189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 30TH ST STE 212",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011087",
            "telephone_number": "720-591-4664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 30TH ST STE 212",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011087",
            "telephone_number": "720-591-4664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITTALL",
        "first_name": "HEATHER",
        "middle_name": "T",
        "name_prefix": "Ms.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-27",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "CO",
            "license": "3829",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "3829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

Verify at the official NPI Registry.