Provider Demographics
NPI:1639891310
Name:HEATHER MOLLER
Entity Type:Organization
Organization Name:HEATHER MOLLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-629-9449
Mailing Address - Street 1:70276 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5412
Mailing Address - Country:US
Mailing Address - Phone:506-299-4498
Mailing Address - Fax:
Practice Address - Street 1:70276 3RD ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5412
Practice Address - Country:US
Practice Address - Phone:506-299-4498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty