Mallory Diane Heise, LAC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

220 Ruskin Dr
Colorado Springs, CO 80910-2522

Phone

(719) 314-4277

NPI assigned

Apr 2, 2019

Last updated

Apr 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Soulful Recovery LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Denver, CO
  • NPI 1649954470
  Medicare reassignment NPD
• Eudaimonia Counseling and Recovery Services

  • Mental Health Counselor
  • Colorado Springs, CO
  • NPI 1962052258

  Addiction (Substance Use Disorder)

  NPD Authorized official
• Overcomers Counseling

  • Professional Counselor
  • Colorado Springs, CO
  • NPI 1568016038
  NPD (past)

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1801358650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102522",
            "telephone_number": "719-314-4277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 RUSKIN DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809102522",
            "telephone_number": "719-314-4277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEISE",
        "first_name": "MALLORY",
        "middle_name": "DIANE",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianne Heinlen
• Bethany Michelle Heinrich, NP
• Sarah Kimberly Heinrich, LMT
• Hillary Heintz, MA, CCC-SLP
• Tad Reeve Heinz, MD
• Shyanne Heise, SLP-CCC
• Cory Heisel, PTA
• Meredith Heiss, MS
• Margaret Heistand, LCSW
• Sharon Lynn Heitz, P.T.

• Addiction (Substance Use Disorder) Counselor in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Addiction (Substance Use Disorder) Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.