Provider Demographics
NPI:1417506742
Name:SCHWALEN, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:SCHWALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 N TRAVIS ST APT 2207
Mailing Address - Street 2:
Mailing Address - City:KNOLLWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75092-4098
Mailing Address - Country:US
Mailing Address - Phone:469-416-0587
Mailing Address - Fax:
Practice Address - Street 1:305 W WOODARD ST STE 213
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-3136
Practice Address - Country:US
Practice Address - Phone:903-265-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76963101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional