Provider Demographics
NPI:1497173421
Name:HUITING, HEATHER A (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:HUITING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:GRASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:20403 N LAKE PLEASANT RD STE 117-426
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-9702
Mailing Address - Country:US
Mailing Address - Phone:623-377-9998
Mailing Address - Fax:
Practice Address - Street 1:31110 N 137TH AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-7937
Practice Address - Country:US
Practice Address - Phone:623-377-9998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-154341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ002199Medicaid
AZ002199Medicaid