Provider Demographics
NPI:1689959629
Name:HEGGLUND, CHARITY (MA, LPA)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:
Last Name:HEGGLUND
Suffix:
Gender:F
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 8TH ST STE 724
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6808
Mailing Address - Country:US
Mailing Address - Phone:940-322-3434
Mailing Address - Fax:
Practice Address - Street 1:900 8TH ST STE 724
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6808
Practice Address - Country:US
Practice Address - Phone:940-322-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX36095OtherLICENSED PSYCHOLOGICAL ASSOCIATE