Provider Demographics
NPI:1326194390
Name:WHITIS, HEATHER A (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:WHITIS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WIND HAVEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8010
Mailing Address - Country:US
Mailing Address - Phone:859-224-2273
Mailing Address - Fax:859-224-4675
Practice Address - Street 1:109 WIND HAVEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8010
Practice Address - Country:US
Practice Address - Phone:859-224-2273
Practice Address - Fax:859-224-4675
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100286840Medicaid
KY8557Medicare ID - Type UnspecifiedMEDICARE