Provider Demographics
NPI:1629752928
Name:HOUSE, HEATHER RENEE (LLC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9420
Mailing Address - Country:US
Mailing Address - Phone:231-347-6701
Mailing Address - Fax:
Practice Address - Street 1:1420 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9420
Practice Address - Country:US
Practice Address - Phone:231-347-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health