Provider Demographics
NPI:1245439884
Name:YASOLSKY, HEATHER LORRAINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LORRAINE
Last Name:YASOLSKY
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 1:217 UNION AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3247
Mailing Address - Country:US
Mailing Address - Phone:814-515-9020
Mailing Address - Fax:844-228-0544
Practice Address - Street 1:217 UNION AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-515-9020
Practice Address - Fax:814-228-0544
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022257190001Medicaid