Provider Demographics
NPI:1689187577
Name:TYLER WOOTEN, HEATHER (LICDC, LSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TYLER WOOTEN
Suffix:
Gender:F
Credentials:LICDC, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-0227
Mailing Address - Country:US
Mailing Address - Phone:740-947-6727
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1343
Practice Address - Country:US
Practice Address - Phone:740-370-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161648101YA0400X
OH120878101YA0400X
OHS.2309305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)