Provider Demographics
NPI:1669683892
Name:HERITAGE, THOMAS LEE (LPC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEE
Last Name:HERITAGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 FOXBOROUGH TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-2904
Mailing Address - Country:US
Mailing Address - Phone:817-483-9434
Mailing Address - Fax:
Practice Address - Street 1:4207 FOXBOROUGH TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-2904
Practice Address - Country:US
Practice Address - Phone:817-483-9434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13398101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health