Provider Demographics
NPI:1891360566
Name:PENAFLOR, HEATHER ANN DAMIAN (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER ANN
Middle Name:DAMIAN
Last Name:PENAFLOR
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:CMR 469 BOX 2069
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09227-0021
Mailing Address - Country:US
Mailing Address - Phone:671-486-4349
Mailing Address - Fax:
Practice Address - Street 1:2027 S 61ST ST STE 124
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6817
Practice Address - Country:US
Practice Address - Phone:254-231-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78413101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health