Provider Demographics
NPI:1558641977
Name:COULSON, HEATHER LYNN (PCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:COULSON
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 COURTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2903
Mailing Address - Country:US
Mailing Address - Phone:435-731-0055
Mailing Address - Fax:
Practice Address - Street 1:8559 S MASON MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9381
Practice Address - Country:US
Practice Address - Phone:513-229-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1300018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health