Provider Demographics
NPI:1467764704
Name:KRIMSLY, HEATHER MAY (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAY
Last Name:KRIMSLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-1925
Mailing Address - Country:US
Mailing Address - Phone:541-812-4970
Mailing Address - Fax:541-926-9329
Practice Address - Street 1:1100 7TH AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-1925
Practice Address - Country:US
Practice Address - Phone:541-812-4970
Practice Address - Fax:541-926-9329
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORL59981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health