Provider Demographics
NPI:1376947770
Name:SCHMELZLE, HEATHER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SCHMELZLE
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 1:5506 DERRINGER DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-4110
Mailing Address - Country:US
Mailing Address - Phone:307-299-6128
Mailing Address - Fax:
Practice Address - Street 1:707 W 8TH ST
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-685-8255
Practice Address - Fax:888-852-8319
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC1666101Y00000X
WYPPC 853101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1376947770Medicaid