Provider Demographics
NPI:1134584352
Name:MCGILL, HEATHER DAWN (RBT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DAWN
Last Name:MCGILL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MILL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6697
Mailing Address - Country:US
Mailing Address - Phone:469-601-0989
Mailing Address - Fax:
Practice Address - Street 1:190 CIVIC CIR
Practice Address - Street 2:SUITE #250
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3424
Practice Address - Country:US
Practice Address - Phone:972-219-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB303350103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst