Provider Demographics
NPI:1871904003
Name:HEADRICK, LEWIS BRIGHTHEART (LCSW)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:BRIGHTHEART
Last Name:HEADRICK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 BURR OAK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2285
Mailing Address - Country:US
Mailing Address - Phone:970-391-7220
Mailing Address - Fax:
Practice Address - Street 1:4011 BURR OAK DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2285
Practice Address - Country:US
Practice Address - Phone:970-391-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.00099203121041C0700X
COCSW.099244101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCSW.09924410OtherCOLORADO DIVISION OF PROFESSIONS AND OCCUPATIONS
COLSW.0009920312OtherCOLORADO STATE BOARD OF SOCIAL WORK EXAMINERS