Provider Demographics
NPI:1083053482
Name:HEGER, TALESA MARGARET (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TALESA
Middle Name:MARGARET
Last Name:HEGER
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:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0535
Mailing Address - Country:US
Mailing Address - Phone:701-448-2054
Mailing Address - Fax:
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:
Practice Address - City:TURTLE LAKE
Practice Address - State:ND
Practice Address - Zip Code:58575-4001
Practice Address - Country:US
Practice Address - Phone:701-448-2054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND685-6-1-11101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1451104Medicaid