Provider Demographics
NPI:1952074544
Name:MACH, HEATHER (LPCC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MACH
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 ONYX WAY NE
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-4563
Mailing Address - Country:US
Mailing Address - Phone:651-815-9405
Mailing Address - Fax:
Practice Address - Street 1:2305 MINNESOTA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56304-2424
Practice Address - Country:US
Practice Address - Phone:320-240-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health