Provider Demographics
NPI:1043635220
Name:GOVE, HEATHER JANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JANE
Last Name:GOVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3448 OLD B RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA
Mailing Address - State:WI
Mailing Address - Zip Code:53923-9750
Mailing Address - Country:US
Mailing Address - Phone:608-516-7003
Mailing Address - Fax:
Practice Address - Street 1:2639 NEW PINERY RD # 1
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1110
Practice Address - Country:US
Practice Address - Phone:608-742-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2034-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional