| Doctor Name: | HEIDI FENTON |
| NPI Number: | 1104900059 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | I-06306 |
| Business Practice Address: | 1005 S Monroe Tucumcari, NM - 88401 |
| Business Phone Number: | 5054613013 |
| Business Fax Number: | 5054611169 |
| Mailing Address: | Po Box 514, TUCUMCARI |
| State: | NM |
| Postal Code: | 88401 |
| Phone Number: | 5054618639 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-06306 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |