Provider Demographics
NPI:1114382082
Name:HAXTON, HEATHER (MS, PC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HAXTON
Suffix:
Gender:F
Credentials:MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 TARRINGTON LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2299
Mailing Address - Country:US
Mailing Address - Phone:614-361-9263
Mailing Address - Fax:
Practice Address - Street 1:3911 TARRINGTON LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2299
Practice Address - Country:US
Practice Address - Phone:614-361-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800082101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor