Provider Demographics
NPI:1972171510
Name:BOISE, HEATHER (LMHC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BOISE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CAPITOL DR APT A
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-4541
Mailing Address - Country:US
Mailing Address - Phone:219-869-4196
Mailing Address - Fax:
Practice Address - Street 1:4695 E NORTHFIELD DR
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-1784
Practice Address - Country:US
Practice Address - Phone:317-520-4748
Practice Address - Fax:888-498-5529
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8000969A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health