Provider Demographics
NPI:1851748768
Name:HEATHER DERMYER, LLC
Entity Type:Organization
Organization Name:HEATHER DERMYER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DERMYER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:906-250-3191
Mailing Address - Street 1:3330 CENTENNIAL RDG
Mailing Address - Street 2:#205
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7098
Mailing Address - Country:US
Mailing Address - Phone:906-250-3191
Mailing Address - Fax:
Practice Address - Street 1:3330 CENTENNIAL RDG
Practice Address - Street 2:#205
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7098
Practice Address - Country:US
Practice Address - Phone:906-250-3191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014186103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty