Provider Demographics
NPI:1326634056
Name:HEATHER DEVILLIERS
Entity Type:Organization
Organization Name:HEATHER DEVILLIERS
Other - Org Name:HEATHER DEVILLIERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEVILLIERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:928-225-6838
Mailing Address - Street 1:3366 E ASCONA WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2202
Mailing Address - Country:US
Mailing Address - Phone:928-225-6838
Mailing Address - Fax:
Practice Address - Street 1:3366 E ASCONA WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2202
Practice Address - Country:US
Practice Address - Phone:928-225-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health