Provider Demographics
NPI:1568498681
Name:LATREILLE, HEATHER COLLEEN (MS, LMFT, LPC)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:COLLEEN
Last Name:LATREILLE
Suffix:
Gender:F
Credentials:MS, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 SOUTHWEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6220
Mailing Address - Country:US
Mailing Address - Phone:512-299-9681
Mailing Address - Fax:512-299-9660
Practice Address - Street 1:5901 SOUTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-6220
Practice Address - Country:US
Practice Address - Phone:512-299-9681
Practice Address - Fax:512-299-9660
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62315101YP2500X
TX5169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional