Provider Demographics
NPI:1710396072
Name:WITTMAYER, HEIDI (MS)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WITTMAYER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 MAIN ST
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3358
Mailing Address - Country:US
Mailing Address - Phone:406-969-5183
Mailing Address - Fax:406-281-8308
Practice Address - Street 1:848 MAIN ST
Practice Address - Street 2:SUITE 8A
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3358
Practice Address - Country:US
Practice Address - Phone:406-969-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-11
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8347101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor