Provider Demographics
NPI:1245529817
Name:HALLUM, HEATHER (LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:HALLUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:DUVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2809 FOREST HOME RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5320
Mailing Address - Country:US
Mailing Address - Phone:866-972-1268
Mailing Address - Fax:
Practice Address - Street 1:5395 W ASH ST STE 2
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858-9228
Practice Address - Country:US
Practice Address - Phone:479-339-0039
Practice Address - Fax:479-339-0038
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1412121101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR266079719Medicaid