Provider Demographics
NPI:1205062817
Name:GOW, HEATHER COLLEEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:COLLEEN
Last Name:GOW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4091
Mailing Address - Country:US
Mailing Address - Phone:423-783-7995
Mailing Address - Fax:
Practice Address - Street 1:1104 TUSCULUM BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4091
Practice Address - Country:US
Practice Address - Phone:423-783-7995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2836103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service