Provider Demographics
NPI:1093587354
Name:HEATHER BEERY LLC
Entity Type:Organization
Organization Name:HEATHER BEERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEERY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-345-0125
Mailing Address - Street 1:2435 N MOUNT GILEAD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9207
Mailing Address - Country:US
Mailing Address - Phone:812-345-0125
Mailing Address - Fax:
Practice Address - Street 1:901 S ROGERS ST STE 103
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4760
Practice Address - Country:US
Practice Address - Phone:812-345-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)