Provider Demographics
NPI:1326479387
Name:MILLER, HEATHER (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18085 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:MO
Mailing Address - Zip Code:63334-3620
Mailing Address - Country:US
Mailing Address - Phone:573-470-1860
Mailing Address - Fax:844-270-3702
Practice Address - Street 1:310 BUSINESS HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-1905
Practice Address - Country:US
Practice Address - Phone:573-470-1860
Practice Address - Fax:844-270-3702
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2016-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013008697101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326479387Medicaid
MO1912338849Medicaid