Provider Demographics
NPI:1114230786
Name:DERMYER, HEATHER L (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:DERMYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 VETERANS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4734
Mailing Address - Country:US
Mailing Address - Phone:231-590-7184
Mailing Address - Fax:231-252-4042
Practice Address - Street 1:1212 VETERANS DR STE 204
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4734
Practice Address - Country:US
Practice Address - Phone:231-590-7184
Practice Address - Fax:231-252-4042
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014186101Y00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist