Provider Demographics
NPI:1265648331
Name:ROBERTS, HEATHER (MS, LAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9785 HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-7416
Mailing Address - Country:US
Mailing Address - Phone:501-865-3351
Mailing Address - Fax:501-865-3362
Practice Address - Street 1:3399 FINCH ROAD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929
Practice Address - Country:US
Practice Address - Phone:501-865-3363
Practice Address - Fax:501-865-3362
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0003011101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional