Provider Demographics
NPI:1831634732
Name:ELLETT, HEATHER LEA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEA
Last Name:ELLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8855 LARCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3629
Mailing Address - Country:US
Mailing Address - Phone:214-883-5476
Mailing Address - Fax:
Practice Address - Street 1:10300 N CENTRAL EXPY
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-489-7774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health