Provider Demographics
NPI:1356654230
Name:CAWTHON, HEATHER MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:CAWTHON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5633
Mailing Address - Country:US
Mailing Address - Phone:972-264-0604
Mailing Address - Fax:972-264-9998
Practice Address - Street 1:202 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5633
Practice Address - Country:US
Practice Address - Phone:972-264-0604
Practice Address - Fax:972-264-9998
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63776101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional