Provider Demographics
NPI:1992390330
Name:BEDINGER, HEATHER (MED, LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:BEDINGER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 RIDGETOP DR
Mailing Address - Street 2:
Mailing Address - City:JUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:76247-4260
Mailing Address - Country:US
Mailing Address - Phone:936-465-4222
Mailing Address - Fax:
Practice Address - Street 1:99 TROPHY CLUB DR
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5422
Practice Address - Country:US
Practice Address - Phone:936-465-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health