Provider Demographics
NPI:1629212659
Name:LAND, HEATHER RENEE'
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:RENEE'
Last Name:LAND
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 1:4845 S SHERIDAN RD
Mailing Address - Street 2:SUITE 510
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-5751
Mailing Address - Country:US
Mailing Address - Phone:918-384-0002
Mailing Address - Fax:918-384-0004
Practice Address - Street 1:4845 S SHERIDAN RD
Practice Address - Street 2:SUITE 510
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-5751
Practice Address - Country:US
Practice Address - Phone:918-384-0002
Practice Address - Fax:918-384-0004
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor