Provider Demographics
NPI:1235326133
Name:CHELLETTE, HEATHER GRAHAM (LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:GRAHAM
Last Name:CHELLETTE
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 1:829 E GEORGIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3901
Mailing Address - Country:US
Mailing Address - Phone:318-242-0730
Mailing Address - Fax:318-242-0750
Practice Address - Street 1:829 E GEORGIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-3901
Practice Address - Country:US
Practice Address - Phone:318-242-0730
Practice Address - Fax:318-242-0750
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA4086171M00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1235326133Medicaid