Provider Demographics
NPI:1174257794
Name:HEFFLEY, NOELLE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:HEFFLEY
Suffix:
Gender:F
Credentials:
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 1927
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1927
Mailing Address - Country:US
Mailing Address - Phone:402-937-0108
Mailing Address - Fax:402-387-7565
Practice Address - Street 1:1933 BOSTON CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-1557
Practice Address - Country:US
Practice Address - Phone:402-937-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13046101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health