Provider Demographics
NPI:1851177562
Name:STALLARD, HEATHER LEANN (LPCA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANN
Last Name:STALLARD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 CRAFT COLLY RD
Mailing Address - Street 2:
Mailing Address - City:ERMINE
Mailing Address - State:KY
Mailing Address - Zip Code:41815-9013
Mailing Address - Country:US
Mailing Address - Phone:606-335-0337
Mailing Address - Fax:
Practice Address - Street 1:484 TOLLAGE CRK
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3305
Practice Address - Country:US
Practice Address - Phone:606-230-2255
Practice Address - Fax:606-437-3001
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY240852101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor