Provider Demographics
NPI:1699815019
Name:BAXT, HEATHER S (LMSW, LSC)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:S
Last Name:BAXT
Suffix:
Gender:F
Credentials:LMSW, LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 W COUNTRY GABLES DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3921
Mailing Address - Country:US
Mailing Address - Phone:602-620-1927
Mailing Address - Fax:
Practice Address - Street 1:15533 W PARADISE LN
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-5851
Practice Address - Country:US
Practice Address - Phone:623-546-7205
Practice Address - Fax:623-975-2841
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW10055104100000X
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ886046Medicaid