Provider Demographics
NPI:1013192475
Name:HEATHER R. MCCONNELL, M.A., PLLC
Entity Type:Organization
Organization Name:HEATHER R. MCCONNELL, M.A., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:903-759-2402
Mailing Address - Street 1:911 W LOOP 281
Mailing Address - Street 2:SUITE 423
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2900
Mailing Address - Country:US
Mailing Address - Phone:903-759-2402
Mailing Address - Fax:903-759-2570
Practice Address - Street 1:911 W LOOP 281
Practice Address - Street 2:SUITE 423
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2900
Practice Address - Country:US
Practice Address - Phone:903-759-2402
Practice Address - Fax:903-759-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19658101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035NFOtherBLUE CROSS BLUE SHIELD