Provider Demographics
NPI:1023447273
Name:DAVIS, HEATHER ANNE (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:DAVIS
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 1:2952 S APPIA AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7951
Mailing Address - Country:US
Mailing Address - Phone:208-890-4451
Mailing Address - Fax:
Practice Address - Street 1:3043 S MERIDIAN RD
Practice Address - Street 2:SUITE 125
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7922
Practice Address - Country:US
Practice Address - Phone:208-884-0033
Practice Address - Fax:208-884-5258
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5022101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor