Provider Demographics
NPI:1255672515
Name:FRASER, HEIDI MARTHA (MA LPC CAADC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARTHA
Last Name:FRASER
Suffix:
Gender:F
Credentials:MA LPC CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MEADOWVIEW LN
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-9366
Mailing Address - Country:US
Mailing Address - Phone:989-419-0969
Mailing Address - Fax:
Practice Address - Street 1:148 MEADOWVIEW LN
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9366
Practice Address - Country:US
Practice Address - Phone:989-419-0969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014073101YP2500X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)