Provider Demographics
NPI:1013152149
Name:BOBO, HEATHER E (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:BOBO
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 1:3630 FM 2181
Mailing Address - Street 2:SUITE 119
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7646
Mailing Address - Country:US
Mailing Address - Phone:940-390-5134
Mailing Address - Fax:
Practice Address - Street 1:3630 FM 2181
Practice Address - Street 2:SUITE 119
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7646
Practice Address - Country:US
Practice Address - Phone:940-390-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53283101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional